Veterans with Heart Disease, Depression Less Likely to Receive Care

The Department of Veterans Affairs (VA) has been criticized regarding long wait times and poor care received by US military veterans at VA clinics. There are some reports that patients waited more than 100 days for an appointment at clinics in some states, which could result in poor outcomes.

Veterans who have been diagnosed with both heart disease and depression may also be facing financial barriers to care. These individuals were found to be more likely to have problems affording medications and services than veterans with heart disease but who did not suffer from depression, according to a study presented at the American Heart Association’s Quality of Care and Outcomes Research 2017 Scientific Sessions.

Veterans with both conditions were also more likely to report delays in seeking care compared with those without depression.

Included in the study were 13,126 veterans who had been diagnosed with heart attack, stroke, angina, or coronary heart disease, who were included in the CDC’s 2013 Behavioral Risk Factor Surveillance System survey.

Approximately 22% of participants had been diagnosed with both heart disease and depression. These patients were more likely to be older and non-white. They were also less likely to be employed, own a home, and were observed to have a lower income, according to the study.

The authors found that patients with both diagnoses were also more likely to have high blood pressure, high cholesterol, COPD, chronic kidney disease, asthma, smoking, obesity, and be physically inactive.

Compared with heart disease patients who do not have depression, those with depression were twice as likely to struggle to afford care, and twice as likely to delay care, according to the study. Of these patients, 45% reported struggling to afford prescription drugs.

Cost concerns have been known to cause patients to skip doses or modify their treatment, which could have a detrimental effect on health.

“All healthcare providers who treat veterans with depression should routinely ask their patients about any difficulty with being able to pay for medical care or medications,” said the study’s senior author, Puja Parikh, MD, MPH. “In some cases, less expensive medications can be considered and 90-day supply of drugs can be prescribed instead of a 30-day supply which can reduce costs. We can also recommend working with a social worker to obtain vouchers or coupons from pharmaceutical companies to get further financial assistance with medication costs.”

Both heart disease and depression are conditions that can result in serious harm if proper medication and care are received. Providing access to less costly drugs and discounts would likely improve care among these patients.

The authors advise that physicians should screen heart patients for depression and monitor them for electrocardiogram abnormalities, since certain anti-depressants can lead to arrhythmias, according to the study.

Patients should also be educated about how to take their prescription drugs to ensure they remain adherent to their treatment regimens.

Future studies should explore how other mental health disorders, including post-traumatic stress disorder, can affect care, according to the authors.

“Further, VA-based research could shed more light on how mental illness affects heart disease care for veterans,” Dr Parikh concluded.