FREQUENCY OF CLINICAL DEPRESSION AND EFFECT OF ANTIDEPRESSANT TREATMENT ON OUTCOMES IN HEART FAILURE WITH REDUCED EJECTION FRACTION (HFREF) AT PIMS

Abstract

Background: Heart Failure with Reduced Ejection Fraction (HFrEF) is frequently associated with clinical depression, which adversely affects treatment adherence, self-care, healthcare utilization, and clinical outcomes. Evidence regarding the effect of antidepressant therapy on both psychological and cardiovascular outcomes among patients with HFrEF remains limited, particularly in Pakistan. Objective: To determine the frequency of clinical depression and evaluate the effect of antidepressant therapy on depressive symptoms, medication adherence, heart failure-related hospital admissions, emergency department visits, and short-term mortality among patients with HFrEF presenting to the Pakistan Institute of Medical Sciences (PIMS), Islamabad. Methods: A Cross Sectional study was conducted in the Department of Cardiology, PIMS, Islamabad, over three months. A total of 323 adult patients with HFrEF and clinical depression identified using the Patient Health Questionnaire-9 (PHQ-9) were enrolled through non-probability consecutive sampling. All participants received sertraline (50–100 mg/day) according to psychiatric assessment and were followed for three months. Depression severity, medication adherence, heart failure-related hospital admissions, emergency department visits, and all-cause mortality were evaluated before and after treatment. Statistical analysis was performed using SPSS version 23.0, with p<0.05 considered statistically significant. Results: The mean baseline PHQ-9 score significantly decreased from 13.9 ± 4.8 to 8.2 ± 4.1 after three months (p<0.001). Good medication adherence improved from 57.3% to 86.1% (p<0.001). Heart failure-related hospital admissions decreased from 29.1% to 14.6% (p=0.002), while emergency department visits declined from 37.5% to 18.3% (p<0.001). During follow-up, the all-cause mortality rate was 1.9%. Conclusion: Sertraline therapy was associated with significant improvement in depressive symptoms and medication adherence, accompanied by reductions in heart failure-related hospital admissions and emergency department visits among patients with HFrEF. Routine depression screening and integrated psychiatric care may improve short-term clinical outcomes in this population. Larger multicenter studies with longer follow-up are warranted to confirm these findings.