Sertraline did not decrease depression in patients with heart failure

January 01, 0001

Sertraline did not decrease depression in patients with heart failure

The objective of this study by researchers from the US was to test the hypothesis that HF patients treated with sertraline will have lower depression scores and fewer cardiovascular events compared with placebo. The SADHART- CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial was a randomized, double-blind, placebo- controlled trial of sertraline 50 to 200 mg/day versus matching placebo for 12 weeks. All participants also received nurse- facilitated support. Eligible patients were age 45 years or older with HF (left ventricular ejection fraction less than or equal to 45%, New York Heart Association functional class II to IV) and clinical depression (Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for current major depressive disorder). Those with significant cognitive impairment, psychosis, recent alcohol or drug dependence, bipolar or severe personality disorder, active suicidal ideation, and current antipsychotic or antidepressant medications were excluded. A total of 469 patients were randomized (n = 234 sertraline, n = 235 placebo).

The mean change from baseline to 12 weeks in the Hamilton Depression Rating Scale total score was -7.1 (sertraline) and -6.8 (placebo) (significant from baseline). The proportions whose composite cardiovascular score worsened, improved, or was unchanged were 29.9%, 40.6%, and 29.5%, respectively, in the sertraline group and 31.1%, 43.8%, and 25.1%, respectively, in the placebo group (not significant).

The researchers concluded: "Sertraline was safe in patients with significant HF. However, treatment with sertraline compared with placebo did not provide greater reduction in depression or improved cardiovascular status among patients with HF and depression."

This is reassuring with regard to the heart, but not with regard to the antidepressant effect. This may reflect the effect of heart failure on mental wellbeing.

For the full abstract, click here.

J Am Coll Cardiol 56(6):92-699, 24 August 2010
© 2010 by the American College of Cardiology Foundation
Results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) Trial. Christopher M. O'Connor, Wei Jiang, Maragatha Kuchibhatla et al for the SADHART-CHF Investigators. Correspondence to Christopher O'Connor: [email protected]

Category: K. Circulatory, P. Psychological. Keywords: depression, heart failure, sertraline, safety, efficacy, randomized, double-blind, placebo-controlled trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 12 October 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.