Depression increases likelihood of non-adherence to medical therapy post-PCI

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Patients with depression were 10–20% less likely to adhere to guideline-directed medical therapy after percutaneous coronary intervention (PCI), research published in JAMA Network Open has shown.

According to Matthew E Lapa (University of Pittsburgh School of Medicine, Pittsburgh, USA) and colleagues, who conducted the research, the recognition of depression among patients undergoing PCI may facilitate targeted interventions to address issues surrounding medical adherence and improve secondary cardiovascular disease prevention.

Lapa and colleagues conducted a retrospective cohort study of patients undergoing PCI from January 2014 to December 2019, using data from the Optum Clinformatics DataMart database. The study team identified a diagnosis of depression as occurring during the 12 months of enrolment prior to PCI, or within six months after the procedure.

Medication adherence was assessed with the proportion of days covered (PDC), calculated as the ratio of the number of days a medication is available and the number of follow-up observation days. Twelve-month adherence was categorised as adequate (PDC ≥80% to <90%) or optimal (PDC ≥90%).

A total of 124,443 patients were included in the assessment, with a mean age of 69.3 years, 41,430 of whom (33.3%) were female. Of this population, 20,711 patients (16.6%) had a diagnosis of depression.

The researchers found that those with depression were significantly less likely to obtain adequate 12-month adherence to antiplatelets (odds ratio [OR], 0.80; 95% confidence interval [CI] 0.77–0.85), β-blockers (OR, 0.84; 95 CI, 0.80–0.88), and statins (OR, 0.88; 95% CI, 0.85–0.93) than those without depression. There was there was no association between depression and adherence to renin-angiotensin-aldosterone system inhibitors (OR, 0.93; 95% CI, 0.85–1). Those with depression had similarly decreased likelihood of optimal 12-month adherence to antiplatelets, β-blockers, and statins as well as renin-angiotensin-aldosterone system inhibitors (OR, 0.87; 95% CI, 0.82–0.94), the researchers report.

“These results indicate the critical importance of strategies to address depression as part of secondary cardiovascular disease prevention,” Lapa et al wrote. “The American Heart Association has advised depression screening for all patients with coronary disease given the adverse contribution of depression to cardiac prognosis. However, depression commonly goes unrecognised and undertreated in clinical settings.

“Either due to resistance from patients to report their depressive symptoms or poor screening practices, our findings of depression negatively affecting medication adherence could be underestimated. We advocate for multidisciplinary interventions to ensure frequent follow-ups, prescription reminders, and counselling to target challenges to medical adherence.”

The study’s authors note that their research has several limitations, chiefly that it only included individuals with insurance, the potential for misclassification of depression status due to reliance on claims data, the use of records from prescription fills to determine adherence, and finally the potential for residual confounding from unmeasured variables that may be associated with depression and adherence.


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