title: Prevention of depression in patients with acute coronary syndrome (DECARD) randomized trial: effects on and by self-reported health.
abstract: OBJECTIVE
  Escitalopram may prevent depression following acute coronary syndrome. We sought to estimate the effects of escitalopram on self-reported health and to identify subgroups with higher efficacy.
  
  
  METHODS
  This is a secondary analysis of a 12-month double-blind clinical trial randomizing non-depressed acute coronary syndrome patients to escitalopram (n = 120) or matching placebo (n = 120). The main outcomes were mean scores on Short Form 36 Health Survey (SF-36) domains, and diagnosis of depression was adjusted for baseline SF-36 scores.
  
  
  RESULTS
  Escitalopram did not yield different SF-36 trajectories on any scale compared with placebo (P > 0.28). Efficacy of escitalopram may have been better among those scoring at least the normative score on general health perceptions (hazard ratio (HR) for depression 0.17 (95% confidence interval 0.02-1.42) ) or social functioning (HR = 0.12 (0.02-0.99) ) than in the full sample of patients (HR = 0.20 (0.04-0.90) ), although not statistically significant.
  
  
  CONCLUSIONS
  The SF-36 may be too broad an outcome measure in trials or treatments that seek to prevent depression following acute coronary syndrome. The SF-36 may, however, indicate who is more likely to benefit from treatment.
authors.affiliation: Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Carsten Rygaard
authors.identifier: http://orcid.org/0000-0002-6943-4785
authors.initials: CR
authors.lastname: Hjorthøj
authors.affiliation: Department of Liaison Psychiatry, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Baiba Hedegaard
authors.initials: BH
authors.lastname: Hansen
authors.affiliation: Department of Liaison Psychiatry, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Jamal Abed
authors.initials: JA
authors.lastname: Hanash
authors.affiliation: Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Alice
authors.initials: A
authors.lastname: Rasmussen
authors.affiliation: Department of Liaison Psychiatry, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Birket-Smith
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use*; D003863:Depression / Q000150:complications* / Q000188:drug therapy / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057566:Self Report; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram
keywords: acute coronary syndrome; depression; escitalopram; prevention; self-reported health