Meta-Analysis of Antidepressant Pharmacotherapy in Patients Eligible for Cardiac Rehabilitation: ANTIDEPRESSANT AMBIVALENCE.
Meta-Analysis of Antidepressant Pharmacotherapy in Patients Eligible for Cardiac Rehabilitation: ANTIDEPRESSANT AMBIVALENCE.
复制标题
DOI：
10.1097/hcr.0000000000000699
复制
发表时间：
2022-11-01
影响因子：
3.8
通讯作者：
中科院分区：
文献类型：
--
作者：
许多患者在心脏康复（CR）登记时表现出临床显著的抑郁。抗抑郁药是治疗抑郁症的首选药物，但抗抑郁药对心脏病患者的疗效参差不齐。本荟萃分析的目的是评估抗抑郁药对符合CR条件的抑郁症患者的疗效。我们进行了一项荟萃分析，包括1990年1月至2021年9月抗抑郁药的随机对照试验，将抗抑郁药与安慰剂进行比较。随机效应模型用于组间效应大小（对冲系数g）。共有13项试验，主要是白人（68%±12;n =7）男性（70%±11），平均年龄为61±5岁，比较了抗抑郁药（1128名参与者）和安慰剂（1079名参与者）。抗抑郁药减轻抑郁症状（g =0）。17: 95% CI, 0.08 - 0.27)，但效果很小。研究效果的异质性较低（I2 = 6.42）且不显著（Q = 10.75, P = 0.46），尽管HF患者（gHF = 0.05, 95% CI, - 0.09 - 0.18）与其他心血管疾病患者相比，其影响较小（gnon-HF = 0.22, 95% CI, 0.11 - 0.32）；（qb [1] = 3.97; p < 0.05）。没有研究报告与抗抑郁药有关的安全问题。抗抑郁药物治疗在这一人群中的效果很小。没有关于运动和药物治疗联合作用的试验报道。如果没有明显的自杀倾向，CR工作人员可以考虑患者的偏好，并在必要时转诊患者进行额外治疗。在12项比较抗抑郁药和安慰剂的试验的荟萃分析中，评估了抗抑郁药对符合CR条件的抑郁症患者的疗效。抗抑郁药的效果很小，在心衰患者中效果更小。没有注意到安全问题。没有试验评估抗抑郁药与CR参与同时进行。
Many patients exhibit clinically significant depression upon enrollment in cardiac rehabilitation (CR). Antidepressants are a first line treatment option for depression, but the effectiveness of antidepressants in patients with heart disease is mixed. The purpose of this meta-analysis was to evaluate the efficacy of antidepressants for depression in patients eligible for CR. A meta-analysis was conducted including randomized controlled trials of antidepressants from January 1990 to September 2021 that compared antidepressants to placebo. Random effects models were used to between groups effect sizes (hedges g). A total of 13 trials with predominately white (68% ± 12; n =7) male (70% ± 11) samples averaging 61 ± 5 yr compared antidepressants (1,128 participants) to placebo (1,079 participants). Antidepressants reduced depressive symptoms (g =0 .17: 95% CI, 0.08 – 0.27), but the effect was small. Heterogeneity among study effects was low (I2 = 6.42) and non-significant (Q = 10.75, P = .46), although patients with HF (gHF = 0.05: 95% CI, −0.09 – 0.18) demonstrated smaller effects compared to patients with other cardiovascular disease conditions (gnon-HF = 0.22: 95% CI, 0.11 – 0.32); (QB [1] = 3.97; P < .05). No study reported safety concerns associated with antidepressants. The effect size of antidepressant pharmacotherapy in this population is small. No trials reported on the combined effects of exercise and pharmacotherapy. Absent significant suicidality, CR staff may consider patient preference and refer patients for additional treatment as necessary. The efficacy of antidepressants for depression in patients eligible for CR was evaluated in a meta-analysis of 12 trials comparing antidepressants to placebo. The effect of antidepressants was small, and smaller among patients with HF. No safety concerns were noted. No trials evaluated antidepressants concurrent with CR participation.