Summary of findings 4. Summary of findings table ‐ Pharmacological treatment 1 compared to pharmacological treatment 2 for depression in patients with coronary artery disease.
| Pharmacological treatment 1 compared to pharmacological treatment 2 for depression in patients with coronary artery disease | ||||||
| Patient or population: health problem or population Setting: cardiology in‐ and outpatient settings Intervention: Pharmacological intervention 1 Comparison: Pharmacological intervention 2 | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with Pharmacological intervention 2 | Risk with Pharmacological intervention 1 | |||||
| Depression symptoms ‐ short term (end of treatment) assessed with: objective measure of depression (Hamilton Rating Scale for Depression); higher scores indicate more severe symptoms | Not pooled | Not pooled | Not pooled | 442 (4 RCTs) | ‐ | No meta‐analysis performed due to clinical heterogeneity. The evidence is very uncertain as to whether different pharmacological interventions may result in a reduction in depression symptoms at the end of treatment for: simvastatin compared to atorvastatin (Abbasi 2015); sertraline plus omega‐3 compared to sertraline plus placebo (Carney 2009); paroxetine compared to fluoxetine (Tian 2016); escitalopram compared to Bu Xin Qi (Wang 2020). |
| Depression remission ‐ short term (end of treatment) assessed with: below cut‐points on objective and self‐report measures of depression | Not pooled | Not pooled | Not pooled | 243 (3 RCTs) | ‐ | No meta‐analysis performed due to clinical heterogeneity. The evidence is very uncertain about the effect of pharmacological treatment compared to another pharmacological treatment on depression remission at the end of treatment . |
| All‐cause mortality ‐ short term (end of treatment) assessed with: mortality records | 26 per 1000 | 68 per 1000 (14 to 281) | OR 2.72 (0.51 to 14.49) | 149 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b | The evidence from 1 trial is very uncertain about the effect of sertraline vs Shugan Jieyu on all‐cause mortality at the end of treatment (Liu 2016). |
| Cardiovascular mortality ‐ short term (end of treatment) ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | No data for cardiovascular mortality at end of treatment in trials comparing a pharmacological intervention versus another pharmacological intervention |
| Myocardial infarction ‐ short term (end of treatment) assessed with: standardised criteria for fatal and non‐fatal myocardial infarction | Not pooled | Not pooled | Not pooled | 396 (3 RCTs) | ‐ | No meta‐analysis performed due to clinical heterogeneity. The evidence is very uncertain about the effect of pharmacological treatment compared to another pharmacological treatment on the occurrence of myocardial infarction at end of treatment for: sertraline plus omega‐3 compared to sertraline plus placebo (Carney 2009); paroxetine compared to fluoxetine (Tian 2016); escitalopram compared to Bu Xin Qi (Wang 2020). |
| *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 | ||||||
| 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_428037497253281678. | ||||||
a Risk of bias rated down one level ‐ the trial(s) that contributed to this outcome were rated as unclear or high risk of bias b Imprecision rated down two levels ‐ sparse events and wide confidence intervals encompass an adverse effect to beneficial effect