Depression Associated With Lower Medication Adherence Post-Percutaneous Coronary Intervention

Quite often, individuals diagnosed with coronary artery disease (CAD) already have or develop comorbid depression, which is associated with a 4 times increased risk of cardiovascular morbidity and mortality compared with its absence.

A recent study investigated whether this association was related to the relationship between depression and medication adherence, as individuals with cardiovascular disease and comorbid depression are significantly less likely to adhere to pharmacotherapy than those without depression.

In this retrospective cohort study, the authors gathered data from Optum Clinformatics Datamart, a US database with administrative claims data for more than 60 million people covered by Medicare and/or commercial insurance. Inclusion criteria were adults 18 years of age and older who underwent percutaneous coronary intervention (PCI) between January 1, 2014, and December 31, 2019, and had 12 months of continuous enrollment prior to and after PCI. Additionally, the authors identified a diagnosis of depression as occurring during the 12 months of enrollment prior to PCI or within 6 months following PCI.

Given these criteria, the study included 124,443 participants who underwent PCI (mean [SD] age, 69.3 [10.6] years; 41,430 [33.3%] female; 3694 [3.0%] Asian, 12,611 [10.1%] Black, and 12,337 [9.9%] Hispanic) and there were 20,711 participants (16.6%) identified as having depression (SD age, 69.1 [10.2] years, 10,513 [50.8%] female, 270 [1.3%] Asian, 2090 [10.1%] Black, and 1969 [9.5%] Hispanic). The median number of comorbidities in those with depression was 9 (6-12), compared with a median of 5 (3-8) in those without depression.

Participants with depression were significantly less likely to have adequate 12-month adherence to antiplatelets (odds ratio [OR], 0.80; 95% 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. This is an approximately 20% lower likelihood of adequate adherence compared with the absence of depression.

Additionally, participants with depression were similarly less likely to have optimal 12-month adherence to antiplatelets (OR, 0.81; 95% CI, 0.77-0.84), β-blockers (OR, 0.79; 95% CI, 0.76-0.82), RAAS inhibitors (OR, 0.87; 95% CI, 0.82-0.94), and statins (OR, 0.84; 95% CI, 0.81-0.87) than those without depression after adjustment.

These results underscore the critical importance of strategies to address depression as part of secondary cardiovascular disease prevention. Although the American Heart Association has recommended depression screening for all patients with CAD, it commonly goes unrecognized and undertreated in clinical settings.

The study authors noted their support for “multidisciplinary interventions to ensure frequent follow-ups, prescription reminders, and counseling to target challenges to medical adherence.”

Given these results, the authors said that additional studies are needed to determine whether treatment of depression may improve medication adherence, as well as how such treatment may improve secondary prevention of cardiovascular disease.

Reference

Lapa M, Swabe G, Rollman B, et al. Assessment of depression and adherence to guideline-directed medical therapies following percutaneous coronary intervention. JAMA Netw Open. 2022;5(12):e2246317. doi:10.1001/jamanetworkopen.2022.46317.