CHF and Depression: Can an SSRI Help Reduce Mortality?

Study findings do not support the use of escitalopram in these patients
Study findings do not support the use of escitalopram in these patients

Treatment with escitalopram for 18 months did not significantly reduce all-cause mortality or hospitalization in patients with chronic heart failure with reduced ejection fraction and depression, when compared with placebo, a study in JAMA reported.

Depression is commonly found in patients with heart failure but the long-term safety and efficacy of selective serotonin reuptake inhibitors (SSRIs) in these patients are unknown. A team of German researchers set out to evaluate whether 24 months of treatment with escitalopram improved mortality, morbidity, and mood in patients with chronic systolic heart failure and depression. 

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The Effects of Selective Serotonin Re-Uptake Inhibition on Morbidity, Mortality, and Mood in Depressed Heart Failure Patients (MOOD-HF) was a double-blind, placebo-controlled, randomized clinical trial where outpatients with New York Heart Association class II–IV heart failure and reduced LVEF (<45%) were screened for depression using the 9-item Patient Health Questionnaire. A total of 342 study patients were randomized to receive escitalopram 10–20mg or a matching placebo for 24 months. 

The composite primary outcome was time to all-cause death or hospitalization and secondary outcomes included safety and depression severity at 12 weeks of treatment (including the titration period). Patients had taken at least one dose of the study drug when the data and safety monitoring committee recommended the trial be stopped early. 

At a median participation time of ~18 months, the primary outcome of death or hospitalization occurred in 63% (n=116) of patients in the escitalopram group and 64% (n=119) of patients in the placebo group (hazard ratio [HR] 0.99, 95% CI: 0.76–1.27; P=0.92). The mean Montgomery-Asberg Depression Rating Scale sum score also changed from 20.2 at baseline to 11.2 at 12 weeks in the escitalopram group vs. 21.4 to 12.5 in the placebo group (difference –0.9, 95% CI: –2.6 to 0.7; P=0.26). Study authors reported comparable safety profiles between the groups.

Escitalopram treatment for 18 months did not significantly reduce all-cause mortality or hospitalization, and did not significantly improve depression when compared to placebo. Study findings do not support the use of escitalopram in patients with chronic systolic heart failure and depression, the authors noted. 

For more information visit jama.jamanetwork.com.

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