MI patients on antidepressants have lower 1-year survival
Research from an observational study in 9000 patients presented at the recent Acute Cardiovascular Care 2018 congress found that heart attack patients prescribed antidepressants have a lower 1-year survival rate than those not on antidepressants. The study found that those prescribed antidepressants at discharge from hospital after a heart attack had a 66% greater risk of mortality one year later than patients not prescribed the drugs, although they noted the cause is not necessarily related directly to the antidepressants.
Data from a Swiss national registry (AMIS Plus) for acute myocardial infarction, were used to analyse 8911 heart attack patients admitted to hospitals in Switzerland between March 2005 and August 2016. Patients were followed up by telephone 12 months after discharge. The researchers compared patients who received antidepressant medication at discharge with those who did not with regard to baseline characteristics and one-year outcomes including mortality, a subsequent heart attack, and stroke.
A total of 565 (6.3%) patients received antidepressants at discharge from hospital. Compared to those who did not receive the drugs, patients prescribed antidepressants were predominantly female, older, and more likely to have hypertension, diabetes, dyslipidaemia, obesity and comorbidities. They were less likely to undergo percutaneous coronary intervention or receive P2Y12 blockers or statins, and stayed in hospital longer.
After adjusting for baseline characteristics the researchers found that the rates of stroke and subsequent heart attacks were similar between the two groups, but patients prescribed antidepressants had significantly worse survival. The rate of all-cause mortality at one-year after discharge was 7.4% in patients prescribed antidepressants compared to 3.4% for those not prescribed antidepressants (p<0.001). Antidepressant prescription was an independent predictor for mortality, and increased the odds by 66% (odds ratio: 1.66; 95% CI: 1.16 to 2.39).
Although this is an observational study and it cannot be concluded that antidepressants caused the higher death rate, more research is needed to pinpoint the causes and underlying pathological mechanisms for the higher mortality observed in this patient group.
Fehr N, et al. Impact of prescribed antidepressants in acute myocardial infarction patients on survival 1 year after discharge. Presented at Acute Cardiovascular Care 2018, a European Society of Cardiology congress. (Moderated Poster Session 1 – Acute Coronary Syndromes, 3 March 2018) .
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