Effects of selective serotonin re-uptake inhibition on MOrtality, mOrbidity, and mood in Depressed Heart Failure patients | Clinical Trial - MOOD-HF

Mar 16, 2015
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Presenter/Author:
Christiane E. Angermann
Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Date Presented:
03/16/2015
Original Posted Date:
03/16/2015
References

Description:

The goal of the trial was to evaluate escitalopram compared with placebo among patients with chronic systolic heart failure and comorbid depression.

Contribution to the Literature: The MOOD-HF trial showed that escitalopram did not improve death or hospitalization, or improve depression symptoms among patients with chronic heart failure.


Study Design

  • Parallel
  • Randomized
  • Placebo
  • Blinded
  • Stratified

Patients with chronic systolic heart failure and comorbid depression were randomized to escitalopram (n = 185) versus placebo (n = 187).

Patient population:

  • Total number of enrollees: 372
  • Duration of follow-up: median 18.4 months
  • Mean patient age: 62 years
  • Percentage female: 24%
  • Percentage diabetics: 32%

Inclusion criteria:

  • Patients >18 years with chronic systolic heart failure (left ventricular ejection fraction <45% and New York Heart Association class II-IV) and a current episode of major depression (diagnosed by a psychiatrist)

Exclusion criteria:

  • Current treatment with an SSRI or other antidepressant
  • Previous treatment failure or contraindication to escitalopram
  • Acute myocardial infarction in prior 3 months, acute decompensated heart failure, recent/planned heart surgery, advanced renal failure
  • Risk of suicide, ≥ moderate dementia, or depression with psychotic features

Principal Findings:

The primary outcome of death or hospitalization occurred in 116 subjects in the escitalopram group versus 119 subjects in the placebo group (p = 0.92). Lower-risk patients appeared to derive more benefit from escitalopram versus placebo (p for interaction = 0.002).

Secondary outcomes:

  • Major depression: similar between groups (p = 0.26)
  • Non-cardiovascular death or non-heart failure hospitalization: 102 subjects vs. 108 subjects (p = NS), respectively, for escitalopram vs. placebo
  • Serious adverse events: 46% vs. 48% (p = 0.68), respectively, for escitalopram vs. placebo

Interpretation:

Among patients with chronic systolic heart failure and comorbid depression, escitalopram did not reduce death/hospitalization, or improve depression symptoms. There was possible benefit among younger patients with less comorbidity. Optimal heart failure therapy among patients with chronic systolic heart failure and depression remains the principal treatment strategy.

References:

Presented by Dr. Christiane Angermann at ACC.15, San Diego, CA, March 16, 2015.

Keywords: ACC Annual Scientific Session, Cardiomyopathies, Citalopram, Depression, Depressive Disorder, Depressive Disorder, Major, Double-Blind Method, Electrocardiography, Heart Failure, Heart Failure, Systolic, Hospitalization, Inflammation, Odds Ratio, Quality of Life, Serotonin, Serotonin Uptake Inhibitors, Stroke Volume, Time


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