“This suggests a somewhat attenuated improvement in heart failure in the escitalopram group,” the cardiologist observed.
The investigators conducted a post hoc analysis to generate a hypothesis-generating risk score for the primary outcome. One point each was given for age greater than 62.6 years, a baseline NT-proBNP level in excess of 807 ng/L, a heart rate greater than 68 bpm, being New York Heart Association class III/IV, and having a left ventricular end diastolic diameter in excess of 59 mm. These were thresholds that identified patients in the top half of the study population for each of these variables.
In patients with a risk score of 0-2, escitalopram was associated with a highly significant 33% reduction in the risk of death or unplanned hospitalization compared with placebo. However, in patients with a score of 3-5, the escitalopram group had a 52% greater risk of the primary endpoint than controls.
“This suggests a heterogeneous pathophysiology and an impact of individual disease profiles on the effects of the study medication,” Dr. Angermann said.
MOOD-HF was funded chiefly by the German Ministry of Education and Research and the University of Wurzburg. Lundbeck provided the escitalopram gratis. Dr. Angermann reported serving as a consultant to ResMed, Novartis, and Vifor and receiving research grants from Lundbeck, Alere, and Boehringer Ingelheim.