title: Characteristics of depression remission and its relation with cardiovascular outcome among patients with chronic heart failure (from the SADHART-CHF Study).
abstract: Depression is prevalent in patients with heart failure and is associated with a significant increase in hospitalizations and death. Primary results of the Sertraline Against Depression and Heart Disease in Chronic Heart Failure (SADHART-CHF) trial revealed that sertraline and placebo had comparable effects on depression and cardiovascular outcomes. In this study, we explored whether remission from depression was associated with better survival and aimed to characterize participants who remitted during the trial. Based on depression response during the 12-week treatment phase, SADHART-CHF participants were divided into 2 groups: (1) remission, defined as participants whose last measured Hamilton Depression Rating Scale (HDRS) score was <8, and (2) nonremission, defined as participants whose last measured HDRS score was ≥8. Patients who dropped out before having any repeat HDRS were not included. Baseline characteristics and survival differences up to 5 years were evaluated between the remission and nonremission groups. Of the 469 SADHART-CHF participants, 208 (44.3%) achieved remission, 194 (41.4%) remained depressed, and 67 (14.3%) dropped out or died without any repeat HDRS assessment. Patients in the remission group had significantly fewer cardiovascular events than those in the nonremission group (1.34 ± 1.86 vs 1.93 ± 2.71, adjusted p = 0.01). Men patients were more likely to remit than women patients (56.5 vs 44.8%, p = 0.02). The remission group had milder depressive symptoms at baseline compared to the nonremission group (HDRS 17.0 ± 5.4 vs 19.6 ± 5.5, Beck Depression Inventory scale 17.9 ± 6.5 vs 20.3 ± 7.2, p <0.001 for the 2 comparisons). In conclusion, this study indicates that remission from depression may improve the cardiovascular outcome of patients with heart failure.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. jiang001@mc.duke.edu
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.forename: Ranga
authors.initials: R
authors.lastname: Krishnan
authors.forename: Maragatha
authors.initials: M
authors.lastname: Kuchibhatla
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cuffe
authors.forename: Carolyn
authors.initials: C
authors.lastname: Martsberger
authors.forename: Rebekka M
authors.initials: RM
authors.lastname: Arias
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D002908:Chronic Disease; D018849:Controlled Clinical Trials as Topic; D003863:Depression / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction; D012107:Research Design; D020280:Sertraline / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D020280:Sertraline