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


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


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.


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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  • Sources of funding National Heart, Lung and Blood Institute of the National Institutes of Health (Grant R01-HL081131/HL/NHLBI NIH HHS); National Alliance for Research in Schizophrenia and Depression, Suzanne C. Murphy Foundation, Thomas and Caroline Royster Research Fund.


  • Competing interests None

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