Rieckmann Nina, Kronish Ian M, Haas Donald, Gerin William, Chaplin William F, Burg Matthew M, Vorchheimer David, Davidson Karina W
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA.
Am Heart J. 2006 Nov;152(5):922-7. doi: 10.1016/j.ahj.2006.05.014.
Even mild depressive symptoms during hospitalization are an independent risk factor for mortality after acute coronary syndromes (ACS). The mortality risk is highest for patients whose depressive symptoms persist after ACS. Low adherence to medications that reduce the risk of subsequent cardiac events may be one of the mechanisms underlying the relationship between persistent depression and risk of ACS recurrence. We compared electronically monitored adherence to aspirin in 3 groups of patients with ACS: persistently depressed, remittent depressed, and persistently nondepressed.
Using an electronic device stored in the cap of a pill bottle, we monitored aspirin adherence over a 3-month period in 165 consecutive patients recruited within 1 week of an ACS event. Depressive symptom severity was assessed by using the Beck Depression Inventory at baseline and at 3 months. Adherence was determined by the percentage of days aspirin was taken as prescribed.
Among the patients, 10.5% of nondepressed patients, 9.8% of remittent depressed patients, and 42.1% of persistently depressed patients took aspirin < or of the time (P < .001). Examined a different way, the mean percentage of days that the correct aspirin dosage (1 pill per day for all patients) was taken was significantly lower in the persistently depressed patients (76.1%) than in the remittent depressed (87.4%) and persistently nondepressed (89.5%) patients (P < .01). Remittent depressed patients did not differ from nondepressed patients. Results remained unchanged after controlling for baseline depressive symptom severity and medical comorbidity.
Poor medication adherence--a potentially modifiable behavior--may contribute to the high mortality risk observed in patients with persistent symptoms of depression after ACS.
即使住院期间的轻度抑郁症状也是急性冠脉综合征（ACS）后死亡的独立危险因素。对于ACS后抑郁症状持续存在的患者，死亡风险最高。对降低后续心脏事件风险的药物依从性低可能是持续性抑郁与ACS复发风险之间关系的潜在机制之一。我们比较了三组ACS患者对阿司匹林的电子监测依从性：持续性抑郁患者、缓解性抑郁患者和持续性非抑郁患者。
我们使用储存在药瓶盖中的电子设备，对165例在ACS事件发生后1周内招募的连续患者进行了为期3个月的阿司匹林依从性监测。在基线和3个月时使用贝克抑郁量表评估抑郁症状严重程度。依从性由按处方服用阿司匹林的天数百分比确定。
在患者中，非抑郁患者中有10.5%、缓解性抑郁患者中有9.8%、持续性抑郁患者中有42.1%服用阿司匹林的时间＜或为规定时间的（P＜0.001）。以另一种方式检查，持续性抑郁患者正确服用阿司匹林剂量（所有患者每天1片）的平均天数百分比（76.1%）显著低于缓解性抑郁患者（87.4%）和持续性非抑郁患者（89.5%）（P＜0.01）。缓解性抑郁患者与非抑郁患者无差异。在控制基线抑郁症状严重程度和合并症后，结果保持不变。
药物依从性差——一种潜在可改变的行为——可能导致ACS后有持续性抑郁症状的患者出现高死亡风险。
