Nighttime heart rate predicts response to depression treatment in patients with coronary heart disease

Area of Science:

• Cardiology
• Psychiatry
• Sleep Medicine

Background:

• Patients with coronary heart disease (CHD) and depression have a higher mortality risk if they do not respond to depression treatment.
• Elevated nighttime heart rate (HR) and low heart rate variability (HRV) are linked to both depression and cardiac events in CHD patients.

Purpose of the Study:

• To investigate if elevated nighttime HR and low HRV predict poor response to depression treatment in patients with stable CHD.
• To understand the relationship between cardiovascular autonomic function and treatment outcomes in depressed CHD patients.

Main Methods:

• 124 patients with stable CHD and major depressive episodes underwent 24-hour ambulatory ECG monitoring.
• Patients received up to 16 weeks of cognitive behavior therapy (CBT), alone or with an antidepressant.
• Pre-treatment nighttime HR and HRV were analyzed in relation to depression remission.

Main Results:

• 52% of patients (64/124) achieved remission from depression.
• Patients who did not achieve remission had significantly higher pre-treatment nighttime HR (p=0.03) and lower nighttime HRV (p=0.01) compared to remitters.
• These associations remained significant after adjusting for potential confounding factors.

Conclusions:

• High nighttime HR and low nighttime HRV are predictive of poor response to depression treatment in patients with stable CHD.
• These findings may elucidate the increased mortality risk observed in non-responders to depression treatment among CHD patients.
• Nighttime cardiovascular autonomic function could serve as a biomarker for treatment outcomes in this population.