Antidepressant Use by Class: Association with Major Adverse Cardiac Events in Patients with Coronary Artery Disease

Sherry L. Grace, Jose R. Medina-Inojosa, Randal J. Thomas, Heather Krause, Kristin S. Vickers-Douglas, Brian A. Palmer, Francisco Lopez-Jimenez

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: To assess use of antidepressants by class in relation to cardiology practice recommendations, and the association of antidepressant use with the occurrence of major adverse cardiovascular events (MACE) including death. Methods: This is a historical cohort study of all patients who completed cardiac rehabilitation (CR) between 2002 and 2012 in a major CR center. Participants completed the Patient Health Questionnaire (PHQ-9) at the start and end of the program. A linkage system enabled ascertainment of antidepressant use and MACE through 2014. Results: There were 1,694 CR participants, 1,266 (74.7%) of whom completed the PHQ-9 after the program. Depressive symptoms decreased significantly from pre-(4.98 ± 5.20) to postprogram (3.57 ± 4.43) (p < 0.001). Overall, 433 (34.2%) participants were on antidepressants, most often selective serotonin reuptake inhibitors (SSRI; n = 299; 23.6%). The proportion of days covered was approximately 70% for all 4 major antidepressant classes; discontinuation rates ranged from 37.3% for tricyclics to 53.2% for serotonin-norepinephrine reuptake inhibitors (SNRI). Antidepressant use was significantly associated with lower depressive symptoms after CR (before, 7.33 ± 5.94 vs. after, 4.69 ± 4.87; p < 0.001). After a median follow-up of 4.7 years, 264 (20.9%) participants had a MACE. After propensity matching based on pre-CR depressive symptoms among other variables, participants taking tricyclics had significantly more MACE than those not taking tricyclics (HR = 2.46; 95% CI 1.37-4.42), as well as those taking atypicals versus not (HR = 1.59; 95% CI 1.05-2.41) and those on SSRI (HR = 1.45; 95% CI 1.07-1.97). There was no increased risk with use of SNRI (HR = 0.89; 95% CI 0.43-1.82). Conclusion: The use of antidepressants was associated with lower depression, but the use of all antidepressants except SNRI was associated with more adverse events.

Original languageEnglish (US)
Pages (from-to)85-94
Number of pages10
JournalPsychotherapy and Psychosomatics
Volume87
Issue number2
DOIs
StatePublished - Mar 1 2018

Fingerprint

Antidepressive Agents
Coronary Artery Disease
Depression
Rehabilitation Centers
Serotonin Uptake Inhibitors
Cardiology
Cohort Studies
Cardiac Rehabilitation
Health
Serotonin and Noradrenaline Reuptake Inhibitors

Keywords

  • Antidepressants
  • Cardiac rehabilitation
  • Coronary artery disease
  • Depression
  • Mortality

ASJC Scopus subject areas

  • Clinical Psychology
  • Applied Psychology
  • Psychiatry and Mental health

Cite this

Antidepressant Use by Class : Association with Major Adverse Cardiac Events in Patients with Coronary Artery Disease. / Grace, Sherry L.; Medina-Inojosa, Jose R.; Thomas, Randal J.; Krause, Heather; Vickers-Douglas, Kristin S.; Palmer, Brian A.; Lopez-Jimenez, Francisco.

In: Psychotherapy and Psychosomatics, Vol. 87, No. 2, 01.03.2018, p. 85-94.

Research output: Contribution to journalArticle

Grace, Sherry L. ; Medina-Inojosa, Jose R. ; Thomas, Randal J. ; Krause, Heather ; Vickers-Douglas, Kristin S. ; Palmer, Brian A. ; Lopez-Jimenez, Francisco. / Antidepressant Use by Class : Association with Major Adverse Cardiac Events in Patients with Coronary Artery Disease. In: Psychotherapy and Psychosomatics. 2018 ; Vol. 87, No. 2. pp. 85-94.
@article{f6af10cfea85468fbb90bcce8726e86e,
title = "Antidepressant Use by Class: Association with Major Adverse Cardiac Events in Patients with Coronary Artery Disease",
abstract = "Background: To assess use of antidepressants by class in relation to cardiology practice recommendations, and the association of antidepressant use with the occurrence of major adverse cardiovascular events (MACE) including death. Methods: This is a historical cohort study of all patients who completed cardiac rehabilitation (CR) between 2002 and 2012 in a major CR center. Participants completed the Patient Health Questionnaire (PHQ-9) at the start and end of the program. A linkage system enabled ascertainment of antidepressant use and MACE through 2014. Results: There were 1,694 CR participants, 1,266 (74.7{\%}) of whom completed the PHQ-9 after the program. Depressive symptoms decreased significantly from pre-(4.98 ± 5.20) to postprogram (3.57 ± 4.43) (p < 0.001). Overall, 433 (34.2{\%}) participants were on antidepressants, most often selective serotonin reuptake inhibitors (SSRI; n = 299; 23.6{\%}). The proportion of days covered was approximately 70{\%} for all 4 major antidepressant classes; discontinuation rates ranged from 37.3{\%} for tricyclics to 53.2{\%} for serotonin-norepinephrine reuptake inhibitors (SNRI). Antidepressant use was significantly associated with lower depressive symptoms after CR (before, 7.33 ± 5.94 vs. after, 4.69 ± 4.87; p < 0.001). After a median follow-up of 4.7 years, 264 (20.9{\%}) participants had a MACE. After propensity matching based on pre-CR depressive symptoms among other variables, participants taking tricyclics had significantly more MACE than those not taking tricyclics (HR = 2.46; 95{\%} CI 1.37-4.42), as well as those taking atypicals versus not (HR = 1.59; 95{\%} CI 1.05-2.41) and those on SSRI (HR = 1.45; 95{\%} CI 1.07-1.97). There was no increased risk with use of SNRI (HR = 0.89; 95{\%} CI 0.43-1.82). Conclusion: The use of antidepressants was associated with lower depression, but the use of all antidepressants except SNRI was associated with more adverse events.",
keywords = "Antidepressants, Cardiac rehabilitation, Coronary artery disease, Depression, Mortality",
author = "Grace, {Sherry L.} and Medina-Inojosa, {Jose R.} and Thomas, {Randal J.} and Heather Krause and Vickers-Douglas, {Kristin S.} and Palmer, {Brian A.} and Francisco Lopez-Jimenez",
year = "2018",
month = "3",
day = "1",
doi = "10.1159/000486794",
language = "English (US)",
volume = "87",
pages = "85--94",
journal = "Psychotherapy and Psychosomatics",
issn = "0033-3190",
publisher = "S. Karger AG",
number = "2",

}

TY - JOUR

T1 - Antidepressant Use by Class

T2 - Association with Major Adverse Cardiac Events in Patients with Coronary Artery Disease

AU - Grace, Sherry L.

AU - Medina-Inojosa, Jose R.

AU - Thomas, Randal J.

AU - Krause, Heather

AU - Vickers-Douglas, Kristin S.

AU - Palmer, Brian A.

AU - Lopez-Jimenez, Francisco

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background: To assess use of antidepressants by class in relation to cardiology practice recommendations, and the association of antidepressant use with the occurrence of major adverse cardiovascular events (MACE) including death. Methods: This is a historical cohort study of all patients who completed cardiac rehabilitation (CR) between 2002 and 2012 in a major CR center. Participants completed the Patient Health Questionnaire (PHQ-9) at the start and end of the program. A linkage system enabled ascertainment of antidepressant use and MACE through 2014. Results: There were 1,694 CR participants, 1,266 (74.7%) of whom completed the PHQ-9 after the program. Depressive symptoms decreased significantly from pre-(4.98 ± 5.20) to postprogram (3.57 ± 4.43) (p < 0.001). Overall, 433 (34.2%) participants were on antidepressants, most often selective serotonin reuptake inhibitors (SSRI; n = 299; 23.6%). The proportion of days covered was approximately 70% for all 4 major antidepressant classes; discontinuation rates ranged from 37.3% for tricyclics to 53.2% for serotonin-norepinephrine reuptake inhibitors (SNRI). Antidepressant use was significantly associated with lower depressive symptoms after CR (before, 7.33 ± 5.94 vs. after, 4.69 ± 4.87; p < 0.001). After a median follow-up of 4.7 years, 264 (20.9%) participants had a MACE. After propensity matching based on pre-CR depressive symptoms among other variables, participants taking tricyclics had significantly more MACE than those not taking tricyclics (HR = 2.46; 95% CI 1.37-4.42), as well as those taking atypicals versus not (HR = 1.59; 95% CI 1.05-2.41) and those on SSRI (HR = 1.45; 95% CI 1.07-1.97). There was no increased risk with use of SNRI (HR = 0.89; 95% CI 0.43-1.82). Conclusion: The use of antidepressants was associated with lower depression, but the use of all antidepressants except SNRI was associated with more adverse events.

AB - Background: To assess use of antidepressants by class in relation to cardiology practice recommendations, and the association of antidepressant use with the occurrence of major adverse cardiovascular events (MACE) including death. Methods: This is a historical cohort study of all patients who completed cardiac rehabilitation (CR) between 2002 and 2012 in a major CR center. Participants completed the Patient Health Questionnaire (PHQ-9) at the start and end of the program. A linkage system enabled ascertainment of antidepressant use and MACE through 2014. Results: There were 1,694 CR participants, 1,266 (74.7%) of whom completed the PHQ-9 after the program. Depressive symptoms decreased significantly from pre-(4.98 ± 5.20) to postprogram (3.57 ± 4.43) (p < 0.001). Overall, 433 (34.2%) participants were on antidepressants, most often selective serotonin reuptake inhibitors (SSRI; n = 299; 23.6%). The proportion of days covered was approximately 70% for all 4 major antidepressant classes; discontinuation rates ranged from 37.3% for tricyclics to 53.2% for serotonin-norepinephrine reuptake inhibitors (SNRI). Antidepressant use was significantly associated with lower depressive symptoms after CR (before, 7.33 ± 5.94 vs. after, 4.69 ± 4.87; p < 0.001). After a median follow-up of 4.7 years, 264 (20.9%) participants had a MACE. After propensity matching based on pre-CR depressive symptoms among other variables, participants taking tricyclics had significantly more MACE than those not taking tricyclics (HR = 2.46; 95% CI 1.37-4.42), as well as those taking atypicals versus not (HR = 1.59; 95% CI 1.05-2.41) and those on SSRI (HR = 1.45; 95% CI 1.07-1.97). There was no increased risk with use of SNRI (HR = 0.89; 95% CI 0.43-1.82). Conclusion: The use of antidepressants was associated with lower depression, but the use of all antidepressants except SNRI was associated with more adverse events.

KW - Antidepressants

KW - Cardiac rehabilitation

KW - Coronary artery disease

KW - Depression

KW - Mortality

UR - http://www.scopus.com/inward/record.url?scp=85044049513&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044049513&partnerID=8YFLogxK

U2 - 10.1159/000486794

DO - 10.1159/000486794

M3 - Article

C2 - 29533962

AN - SCOPUS:85044049513

VL - 87

SP - 85

EP - 94

JO - Psychotherapy and Psychosomatics

JF - Psychotherapy and Psychosomatics

SN - 0033-3190

IS - 2

ER -