title: Antidepressant use and risk for mortality in 121,252 heart failure patients with or without a diagnosis of clinical depression.
abstract: BACKGROUND
  Depression is a risk factor for mortality in patients with heart failure (HF), however, treating depression with antidepressant therapy does not seem to improve survival. We examined the prevalence of antidepressant use in HF patients, the correlates of antidepressant use subsequent to hospital discharge and the relation between antidepressant use, clinical depression and mortality in patients with HF.
  
  
  METHODS
  121,252 HF patients surviving first hospitalization were stratified by antidepressant use and a diagnosis of clinical depression.
  
  
  RESULTS
  In total, 15.6% (19,348) received antidepressants at baseline, of which 86.7% (16,780) had no diagnosis of clinical depression. Female gender, older age, higher socio-economic status, more comorbidities, increased use of statins, spironolactone and aspirin, lower use of beta-blockers and ACE-inhibitors, greater HF severity and a diagnosis of clinical depression were independently associated with antidepressant use. Patients using no antidepressants with clinical depression and patients using antidepressants, with or without clinical depression, had a significantly higher risk for all-cause mortality (HR, 1.25; 95% CI, 1.15-1.36; HR, 1.24; 95% CI, 1.22-1.27; HR, 1.21; 95% CI, 1.16-1.27, respectively) and CV-mortality (HR: 1.17; 95% CI, 1.14-1.20, P<.001; HR: 1.20; 95% CI, 1.08-1.34, P<.001; HR: 1.21; 95% CI, 1.12-1.29, P<.001, respectively) as compared to patients not using antidepressants without depression in adjusted analysis.
  
  
  CONCLUSIONS
  Patients with HF taking antidepressants had an increased risk for all-cause and CV-mortality, irrespectively of having clinical depression. These results highlight the importance of further examining the antidepressant prescription pattern in patients with HF, as this may be crucial in understanding the antidepressant effects on cardiac function and mortality.
authors.affiliation: CoRPS - Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
authors.forename: Corline
authors.initials: C
authors.lastname: Brouwers
authors.affiliation: Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
authors.forename: Stefan B
authors.initials: SB
authors.lastname: Christensen
authors.affiliation: CoRPS - Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
authors.forename: Nikki L
authors.initials: NL
authors.lastname: Damen
authors.affiliation: CoRPS - Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
authors.affiliation: Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors.forename: Gunnar H
authors.initials: GH
authors.lastname: Gislason
authors.affiliation: Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Odense University Hospital, Odense, Denmark. Electronic address: sspedersen@health.sdu.dk.
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003718:Denmark / Q000453:epidemiology; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000401:mortality; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressant; Clinical depression; Heart failure; Mortality