Assessment of Depression and Adherence to Guideline-Directed Medical Therapies Following Percutaneous Coronary Intervention.
JAMA Netw Open
; 5(12): e2246317, 2022 12 01.
Article
in En
| MEDLINE
| ID: mdl-36508214
ABSTRACT
Importance Depression is associated with increased risk of primary and secondary cardiovascular events. Medication adherence may play an essential role. Objective:
To evaluate the association of depression and 12-month adherence to guideline-directed medical therapies (eg, antiplatelet agents, ß-blockers, renin-angiotensin-aldosterone system inhibitors [ie, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers], and statins) following percutaneous coronary intervention. Design, Setting, andParticipants:
This retrospective cohort study included individuals who underwent percutaneous coronary intervention from January 1, 2014, to December 31, 2019. Data were collected from a large US health claims database and analyzed between February and August 2022. Main Outcomes andMeasures:
Proportion of days covered (PDC) for classes of guideline-directed medical therapies, with 12-month adherence categorized as adequate (PDC ≥80% to <90%) or optimal (PDC ≥90%). Multivariable-adjusted regression models were used to evaluate the association of depression with adherence; models incorporated demographic characteristics, comorbid medical and psychiatric conditions, depression treatment, and guideline-directed medical therapy treatment adjustment. The hypothesis was that those with depression would have lower odds of either adequate or optimal adherence to agents essential for guideline-directed medical therapy.Results:
Of 124â¯443 individuals (mean [SD] age, 69.3 [10.6] years; 41â¯430 [33.3%] female sex; 3694 [3.0%] Asian, 12â¯611 [10.1%] Black, and 12â¯337 [9.9%] Hispanic individuals) who received percutaneous coronary interventions, 20â¯711 (16.6%) had a diagnosis of depression. Those with depression were significantly less likely to obtain adequate 12-month adherence to antiplatelets (odds ratio [OR], 0.80; 95% CI, 0.77-0.85), ß-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 no association between depression and adherence to renin-angiotensin-aldosterone system inhibitors (OR, 0.93; 95% CI, 0.85-1.00). Those with depression had similarly decreased likelihood of optimal 12-month adherence to antiplatelets, ß-blockers, and statins as well as renin-angiotensin-aldosterone system inhibitors (OR, 0.87; 95% CI, 0.82-0.94). Conclusions and Relevance In this cohort study, patients with depression were less likely to achieve adequate or optimal adherence to medications essential to guideline-directed medical therapies following percutaneous coronary intervention compared with those without depression. Recognition of depression may facilitate targeted interventions to address medication adherence and thereby improve secondary cardiovascular disease prevention.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Hydroxymethylglutaryl-CoA Reductase Inhibitors
/
Percutaneous Coronary Intervention
Type of study:
Etiology_studies
/
Guideline
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limits:
Aged
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Female
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Humans
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Male
Language:
En
Journal:
JAMA Netw Open
Year:
2022
Document type:
Article