Patients diagnosed with depression were less likely to adhere to essential medical therapies after percutaneous coronary intervention (PCI) than those without depression, according to a new study published in JAMA Network Open by School of Medicine researchers from the University of Pittsburgh.
Reviewing claims data, researchers assessed the connection between patients’ depression and medication adherence 12 months after undergoing PCI, a common procedure to open blocked coronary arteries in the heart and around Medications prescribed to these patients include beta-blockers, antiplatelet agents, and statins, all of which have been shown to reduce the likelihood of another heart attack or cardiovascular event.
Previous research has found that patients with depression are up to three times more likely to suffer health problems or die after a heart attack than those without depression.
Depression is known to carry an adverse cardiovascular risk. We wanted to better understand why this is so. We found that 10% to 20% of people with depression were less likely to take their medication after PCI, which is significant, because this group has a higher risk of serious complications or death from a heart attack.”
Jared W. Magnani, MD, M.Sc., UPMC cardiologist and associate professor of medicine at Pitt
The study examined the records of more than 124,000 patients who underwent PCI and were diagnosed with depression by a medical provider. Magnani and his team used medical claims data that incorporated prescriptions filled at pharmacies to track whether patients kept their prescriptions.
Providers know that medication adherence is a critical component of cardiovascular disease prevention, but it is complex. Social factors, such as having money to cover drug costs or having to choose between co-pays for drugs and household essentials, can affect whether a person is able to adhere to their medication. Access to the pharmacy can also be a challenge.
Magnani suggests providers incorporate depression screenings to develop ways to improve medication adherence and health outcomes for patients with depression.
The study also highlights another known association: A significant proportion of people with coronary artery disease have or will develop depression; and people with depression have a four times greater risk of cardiovascular disease.
Study co-author Bruce Rollman, MD, UPMC chair and professor of medicine at Pitt, has led trials to treat depression after heart bypass surgery and after hospital discharge for heart failure.
“This study may help explain why cardiac patients with comorbid depression tend to have higher rates of hospital readmission and mortality than non-depressed cardiac patients,” Rollman said. “It also points to the need for organized health systems, such as UPMC, to routinely screen for and treat depression to maximize the potential benefits for patients from undergoing these high-cost cardiac procedures.”
Magnani noted that depression is a common condition, and the study results indicate that providers need to identify and address depression.
“We provide critical and sometimes life-saving therapies to our patients with heart disease, and then we prescribe therapies that we know can help them. If depression challenges or reduces their ability to adhere to these medications, then it is essential to address depression as part of cardiovascular care and treatment. Our team sees our findings as an invitation to develop strategies to recognize depression as part of cardiovascular care,” Magnani noted.
The researchers acknowledged that the study did not provide insight into why adherence was reduced, but they hope to investigate these causes in the future to provide solutions.
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Journal reference:
Lapa, ME, et al. (2022) Assessment of depression and adherence to guideline-directed medical therapies after percutaneous coronary intervention. Open JAMA Network. doi.org/10.1001/jamanetworkopen.2022.46317.