Antidepressants do not improve event-free survival in patients with heart failure when depressive symptoms remain

Objective: The purpose of this secondary data analysis was to compare event-free survival among four groups of patients with heart failure (HF) that were stratified by presence of depressive symptoms and antidepressants. Methods: We analyzed data from 209 outpatients (30.6% female, 62 +/- 12 years, 54% NYHA Class III/IV) enrolled in a multicenter HF registry who had data on depressive symptoms, antidepressant use, and cardiac rehospitalization and death outcomes during 1 year follow up. Depressive symptoms were assessed using the Patient Health Questionnaire-9. Results: Depressive symptoms, not antidepressant therapy, predicted event-free survival (HR = 2.4, 95% CI = 1.2-4.6, p = .009). Depressed patients without antidepressants had 4.1 times higher risk of death and hospitalization than non-depressed patients on antidepressant (95% CI = 1.2-13.9, p = .022) after controlling for age, gender, NYHA class, body mass index, diabetes, medication of ACEI and beta-blockers. Conclusion: Antidepressant use was not a predictor of event-free survival outcomes when patients still reported depressive symptoms. Ongoing assessment of patients on antidepressants is needed to assure adequate treatment. (C) 2013 Elsevier Inc. All rights reserved.