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Failure to improve during first 6 months of treatment and depression severity predict increased mortality in people with ACS and MDD

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Question

Question:

In people with acute coronary syndrome (ACS) and major depressive disorder (MDD), what features of MDD are associated with long-term mortality?

Population:

369 adults with ACS meeting criteria for MDD who participated in the SADHART randomized controlled trial comparing safety and efficacy of sertraline versus placebo.

Setting:

SADHART study was conducted in 44 outpatient centres in 7 countries; study participants were recruited between April 1997 and December 1999

Prognostic factors:

Baseline depression severity: Hamilton Depression Rating Scale (HAM-D) score of less than 18 vs 18 or higher, onset of MDD before or after index ACS event, previous episodes of MDD; 8 months of sertraline treatment, mood improvement during 6-month placebo or setraline treatment (Clinical Global Impression-Improvement subscale, CGI-I) and left ventricular ejection fraction (LVEF <0.30 vs ≥0.30). Remission was defined as a CGI-I score of 1 (very much improved), which is similar to a Ham-D score of 7 or less. Cox proportional hazards regression models were used to analyse effects of risk factors at time of death and were controlled for age and sex.

Outcomes:

Vital status. Mortalities were collected 5 years after the final participant completed the trial. Evidence of the last date on which …

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