Summary of findings 3. Summary of findings table ‐ Pharmacological treatment compared to placebo for depression in patients with coronary artery disease.
| Pharmacological treatment compared to placebo for depression in patients with coronary artery disease | ||||||
| Patient or population: health problem or population Setting: cardiology in‐ and outpatient settings Intervention: Pharmacological Comparison: Placebo | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with Placebo | Risk with Pharmacological | |||||
| Depression symptoms ‐ short term assessed with: objective and self‐reported measures of depression; higher scores indicate more severe symptoms | ‐ | SMD 0.83 lower (1.33 lower to 0.32 lower) | ‐ | 750 (8 RCTs) | ⊕⊕⊝⊝ Lowa,b | There is low certainty evidence that pharmacological intervention may result in a large reduction in depression symptoms at the end of treatment |
| Depression remission ‐ short term assessed with: below cut‐point on objective measure of depression (Hamilton Rating Scale for Depression) | 323 per 1000 | 496 per 1000 (412 to 580) | OR 2.06 (1.47 to 2.89) | 646 (4 RCTs) | ⊕⊕⊕⊝ Moderatea | There is moderate certainty evidence that pharmacological intervention probably results in a moderate to large increase in depression remission at the end of treatment. |
| All‐cause mortality ‐ short term assessed with: mortality records | 36 per 1000 | 14 per 1000 (4 to 53) | OR 0.38 (0.10 to 1.47) | 437 (2 RCTs) | ⊕⊝⊝⊝ Very lowa,c | The evidence is very uncertain about the effect of pharmacological intervention on all‐cause mortality at the end of treatment. In addition to the pooled results, data could not be extracted from 2 studies where no deaths occurred and from 1 trial which remained unclear. |
| Cardiovascular mortality ‐ short term (end of treatment) ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | No data for cardiovascular mortality at end of treatment in trials comparing pharmacological intervention versus placebo |
| Myocardial infarction ‐ short term assessed with: standardised criteria for fatal or non‐fatal myocardial infarction | 22 per 1000 | 17 per 1000 (6 to 45) | OR 0.74 (0.26 to 2.09) | 728 (3 RCTs) | ⊕⊝⊝⊝ Very lowa,c | The evidence is very uncertain about the effect of pharmacological intervention on myocardial infarction at the end of treatment. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio; SMD: standardised mean difference | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
| See interactive version of this table: https://gdt.gradepro.org/presentations/#/isof/isof_question_revman_web_427666962988765745. | ||||||
a Risk of bias rated down one level ‐ trials that contributed to this outcome were rated as unclear or high risk of bias b Inconsistency rated down one level ‐ though confidence intervals generally overlapped, there was considerable unexplained statistical heterogeneity c Imprecision rated down two levels ‐ sparse events and wide confidence intervals encompass an adverse effect to beneficial effect