The Clinical Efficacy And Safety Of Duloxetine In Patients With Chronic Heart Failure Complicated With Depression And Anxiety

Background: Citalopram belongs to Selective Serotonin Reuptake Inhibitors(SSRIs),SSRIs are the first-line drugs for the treatment of depression and anxiety.The 2014 consensus of Chinese experts pointed out that SSRIs can be used safely in patients with cardiovascular diseases.Duloxetine,as a selective Serotonin and Norepinephrine Reuptake Inhibitors(SNRIs),has good therapeutic effects on depression and anxiety.However,there are few studies on this drug in patients with cardiovascular disease comorbidity depression and anxiety.The purpose of this study was to investigate the efficacy and safety of duloxetine in patients with CHF complicated with depression and anxiety,and to provide a new theore tical basis for its clinical application.Objective: To observe the clinical efficacy and safety of duloxetine in chronic heart failure with depression and anxiety.Methods: Sixty-five cases met the inclusion criteria were randomly divided into 34 cases in the study group and 31 cases in the control group.The study group received conventional anti-heart failure treatment plus duloxetine,and the control group received conventional anti-heart failure treatment plus citalopram.The course of treatment was 8 weeks.Patient Health Questionnaire-9(PHQ-9),General Anxiety Disorder-7(GAD-7)(the score of PHQ-9 and GAD-7 was positively correlated with the degree of depression and anxiety,that is to say,the higher the score,the more serious the degree of depression and anxiety)and Treatment Emergent Symptom Scale(TESS)were used.Patients' cardiac function evaluation indexes Alanine aminotransferase(ALT),Glutamic-oxalacetic transaminase(AST),Creatinine(Cr),Blood Pressure(BP),Heart Rate(HR),Corrected(QT)a nd other safety indexes were monitored before and after treatment.Results:1.Intra-group comparison found that the scores of PHQ-9 at each time point was different after treatment(P<0.01),and with the extension of time,it showed a downward trend.Comparison between groups found that the changes of PHQ-9 at each time point was statistically different after treatment(P<0.05),and the decrease of PHQ-9 in duloxetine group was greater than that in citalopram group.2.Intra-group comparison found that the scores of GAD-7 at each time point was different after treatment(P<0.01),and with the extension of time,showed a downward trend.Comparison between groups found that the changes of GAD-7 at each time point was statistically different after treatment(P<0.05),and the decrease of GAD-7 in duloxetine group was greater than that in citalopram group.3.After treatment,there was no significant difference in cardiac function indicators between the two groups(P>0.05).Intra-group comparison,there was no significant difference in EF,FS before and after treatment in each group,but Compared with that before treatment,BNP,6WMD and NYHA classification in each group showed improvement,which were statistically significant(P<0.05).4.The incidence of side effects had no statistic difference between the two groups(P>0.05).And there was no significant difference in the incidence of adverse cardiac events between the two groups.There was no significant difference in safety indicators before and after treatment in each group(P>0.05).Conclusion: Duloxetine is superior to citalopram in the treatment of depression and anxiety,and the effect on cardiac function was similar to that of citalopram.It can be safely used in patients of CHF with depression and anxiety.