Author + information
- Götz Gelbrich, PhD, MD(Sci)* (, )
- Stefan Störk, MD, PhD,
- Hermann Faller, MD, PhD,
- Georg Ertl, MD and
- Christiane E. Angermann, MD
- ↵*Clinical Trial Center, Härtelstrasse 16-18, D-04107 Leipzig, Germany
Jaarsma et al. (1) present a post hoc subgroup analysis from the COACH (Coordinating study evaluating Outcomes of Advising and Counseling in Heart failure) trial that poses the hypothesis that disease management is beneficial in nondepressed heart failure patients but increases mortality in patients with comorbid depression. Significant test results for interaction of treatment allocation and baseline depression support this concept.
The data indicate that 32% of 201 nondepressed and 21% of 116 depressed control subjects died (hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.38 to 0.97, p = 0.036). In the intervention arm, 22% of 380 nondepressed and 32% of 261 depressed patients died (HR: 1.56, 95% CI: 1.15 to 2.11, p = 0.004). Thus, whereas for the intervention arm, mortality risk concurred with numerous publications unanimously reporting augmentedmortality in depressed cardiovascular patients (e.g., Jiang et al. ; HR: 1.36, 95% CI: 1.09 to 1.70), the reverse was observed in the control subjects.
Actually, a mortality risk comparable to that reported in observational studies would also have been expected in the control subjects. As no intervention was applied, superior survival of depressed control patients is not attributable to specific care. Conversely, had disease management exerted a beneficial effect in the nondepressed patients while worsening survival in the depressed patients, as the investigators propose, a larger mortality difference with a distinctly higher than reported mortality risk in the depressed patients would have been anticipated with the intervention. We, therefore, propose to interpret the reported interaction as a false positive finding, probably caused by a data artifact in the control group.
- American College of Cardiology Foundation