1. Chronic systolic heart failure patients treated for 18 months with escitalopram, an SSRI, did not demonstrate significantly reduced all-cause mortality.
2. It was also shown that chronic heart failure patients treated with escitalopram did not demonstrate significant improvement in depression.
Evidence Rating Level: 1 (Excellent)
Study Rundown: According to the National Institutes of Health (NIH), depression is one of the most common mental disorders in the United States, affecting roughly 16 million adults, or 6.7% of the population over the age of 18. However, depression is not an isolated condition, nor one with a singular cause. For example, depression has been shown to be more common in patients with cardiovascular disease and its presence results in worse overall outcomes for these patients. Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat depression. Only 1 previous randomized controlled trial, lasting just 12 weeks, assessed the effects of SSRIs on patients with heart failure. This study, designed to follow patients for 12 months, was aimed at understanding the long term effects of SSRIs on heart failure.
The study found that in chronic systolic heart failure patients treated with long term (12 months) escitalopram, mortality and hospitalization rates were no different than those treated with a placebo. The study is strengthened by its double-blind, placebo-controlled design, and long follow-up period. However, being a primarily white population from Germany, the study population lacked both ethnic and geographic diversity, possibly limiting generalizability. The results of this trial, combined with those of prior studies, do not support the notion that escitalopram should be used to treat depression in patients with chronic systolic heart failure. Future studies could focus on determining if these results persist with other anti-depressants used in similar patient groups as well as sub-groups such as the elderly, African-Americans, and women.
In-Depth [randomized clinical trial]: This study examined 372 patients with chronic systolic heart failure and depression from 16 tertiary medical centers in Germany. 185 were assigned to receive escitalopram and 187 to the placebo group. Primary outcomes of all-cause death or hospitalization occurred in 116 (63%) patients in the escitalopram group and 119 patients (64%) in the placebo group (HR 0.99; 95%CI 0.76 to 1.27, p = 0.92). Treatment adherence at study visit 3 was 86% but decreased to 73% by study visit 6. The proportion of patients discontinuing treatment after 6 and 12 weeks was 11% and 15% for the escitalopram group and 5% and 7% for the placebo group, respectively.
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