Is It Time to Treat Depression in Patients With Cardiovascular Disease?
Depression has been associated with worse cardiovascular prognosis in individuals with heart disease, particularly among patients with established coronary heart disease1 but also among patients with heart failure.2,3 We can now add to this list those patients with the confluence of heart failure and atrial fibrillation. In this issue of Circulation, Frasure-Smith and colleagues4 evaluate the relationship between depression and cardiovascular mortality among individuals with both heart failure and atrial fibrillation in an analysis from the Atrial Fibrillation and Congestive Heart Failure (AF-CHF) Trial.5 In the main trial, which was a multicenter randomized study conducted across 4 continents, a strategy of rhythm control in patients with atrial fibrillation and heart failure with left ventricular ejection fraction ≤0.35 was comparable to a rate control strategy. The group of patients studied was at particularly high risk given the presence of atrial fibrillation, which is independently associated with mortality in patients with heart failure.
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