Antidepressant Use in Patients With Heart Failure Linked to Polypharmacy, Race

Antidepressant use among patients hospitalized with heart failure (HF) is associated with minor depression, history of major depression, younger age, unemployment, white race, nonischemic HF, polypharmacy, and functional incapacity, according to a study published in General Hospital Psychiatry.

A total of 400 patients who were hospitalized with HF (average age, 58.4±13.1 years) at a large, urban tertiary care teaching hospital between 2014 and 2016 were enrolled in this study. In the primary analysis, researchers measured depression across all patients with a diagnosis based on a structured interview. In the secondary analysis, depression was measured with a Patient Health Questionnaire (PHQ-9) depression score. Patients’ electronic medical records were used to collect sociodemographic data, medical history, and current medical status data. The researchers performed logistic regression analyses to determine independent correlates of antidepressant use in this patient population with HF.

In the primary analysis, patients with major depression and HF did not have a greater likelihood of taking antidepressants compared with patients who did not have depression. Variables associated with antidepressant use in the primary model included white race (odds ratio [OR], 4.38; 95% CI, 2.22-8.65; P <.0001, younger age (OR, 0.87; 95% CI, 0.76-0.99; P =.03), unemployment (OR, 0.40; 95% CI, 0.17-0.94; P =.04), ischemic HF (OR, 0.48; 95% CI, 0.24-0.95; P =.04), number of other prescribed medications (OR, 1.33; 95% CI, 1.18-1.50; P <.0001), the presence of current minor depression (OR, 2.36; 95% CI, 1.05-5.30; P =.04), history of major depression (OR, 2.04; 95% CI, 1.15-3.63; P =.02), and functional impairment (OR, 0.96 95% CI, 0.93-0.99; P =.01).

The secondary analysis identified positive associations between antidepressant use and white race (OR, 4.23; 95% CI, 2.17-8.25; P <.0001), unemployment (OR, 0.40; 95% CI, 0.17-0.94; P =.04), number of other prescribed medications (OR, 1 .33 95% CI, 1.18-1.50; P <.0001), and functional impairment (OR, 0.96; 95% CI, 0.93-0.99; P =.02). Additionally, the effect of current severity of depression was different between patients with vs without a history of major depression in both models.

Limitations of the study included the lack of information on antidepressant use duration, indications for use, or medication adherence.

Based on these findings, the researchers concluded “that many male and African American patients with HF, as well as patients without very salient functional impairment, may not be receiving depression care when they need it,” encouraging clinicians to discuss unmet treatment needs for depression with these patients.

Reference

Freedland KE, Steinmeyer BC, Carney RM, Skala JA, Rich MW. Antidepressant use in patients with heart failure [published online April 25, 2020]. Gen Hosp Psychiatry. doi: 10.1016/j.genhosppsych.2020.04.006.