Depression and heart disease

Citation: Alexander H.Glassman et al. “Psychiatric Characteristics Associated With Long-term Mortality Among 361 Patients Having an Acute Coronary Syndrome and Major Depression.” Arch Gen Psychiatry. 2009;66(9):1022-1029.


Design: Retrospective Cohort (SADHART participants) study Setting: Academic                                   Patients: SADHART Participants (18 yrs or older patients hospitalized for ACS who were found to have MDD on screening) Follow up: 6.7 yrs
Risk factor and exposure: 1.Baseline depression severity, 2. Previous MDD episodes, 3. Onset of MDD before or after the ACS event, 4. 6 months of Sertraline HCl therapy, 5. Mood improvement
Outcome: Vital Status (Mortality)
Analysis: t-test (continuous variables), Chi square (categorical variables), Cox proportional hazards regression models


1, During the study, 75 participants (20.9%) died
2. Neither previous episodes of MDD, nor onset before or after the index ACS, nor an initial 6 months of Sertraline treatment was associated w/ long term mortality.
3. Baseline MDD severity is associated w/ long term mortality, HR-2.30; CI-1.28-4.14; p<.006
4. Failure of MDD to improve substantially during treatment w/ either Sertraline or placebo is associated w/ long term mortality, HR-2.39; CI 1.39-2.44; p<.001

Validity Criteria:
Was the sample of patient representative? Partially
Patient homogenous to prognostic risk? Yes
Was follow up sufficiently complete? Yes
Were outcome criteria objective and unbiased Yes
How likely are the outcomes over time? Yes
How precise are the estimates? Wide confidence intervals
Were the study patients similar to the patients in my care? Partially
Was follow up long enough? Yes
Can I use this information in my practice? Yes



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