University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Center for Behavioral Health and Smart Technology, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
JAMA Netw Open. 2022 Dec 1;5(12):e2246317. doi: 10.1001/jamanetworkopen.2022.46317.
Depression is associated with increased risk of primary and secondary cardiovascular events. Medication adherence may play an essential role.
To evaluate the association of depression and 12-month adherence to guideline-directed medical therapies (eg, antiplatelet agents, β-blockers, renin-angiotensin-aldosterone system inhibitors [ie, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers], and statins) following percutaneous coronary intervention.
DESIGN, SETTING, AND PARTICIPANTS: 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.
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.
Of 124 443 individuals (mean [SD] age, 69.3 [10.6] years; 41 430 [33.3%] female sex; 3694 [3.0%] Asian, 12 611 [10.1%] Black, and 12 337 [9.9%] Hispanic individuals) who received percutaneous coronary interventions, 20 711 (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), 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; 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, β-blockers, and statins as well as renin-angiotensin-aldosterone system inhibitors (OR, 0.87; 95% CI, 0.82-0.94).
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.
抑郁与主要和次要心血管事件的风险增加相关。药物依从性可能起着至关重要的作用。
评估抑郁与经皮冠状动脉介入治疗后 12 个月内指南指导的医学治疗（例如抗血小板药物、β 受体阻滞剂、肾素-血管紧张素-醛固酮系统抑制剂[即血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂]和他汀类药物）的依从性之间的关联。
设计、地点和参与者：这是一项回顾性队列研究，纳入了 2014 年 1 月 1 日至 2019 年 12 月 31 日期间接受经皮冠状动脉介入治疗的患者。数据来自美国大型健康索赔数据库，于 2022 年 2 月至 8 月间进行分析。
指南指导的医学治疗药物的天数覆盖比例（PDC），12 个月的依从性分为足够（PDC≥80%但<90%）或最佳（PDC≥90%）。使用多变量调整回归模型评估抑郁与依从性之间的关系；模型纳入了人口统计学特征、合并的医疗和精神疾病状况、抑郁治疗和指南指导的医学治疗药物调整。假设是抑郁患者获得抗血小板药物、β 受体阻滞剂和他汀类药物等指南指导的医学治疗药物的充分或最佳依从性的可能性较低。
在接受经皮冠状动脉介入治疗的 124443 名患者中（平均[标准差]年龄为 69.3[10.6]岁；41430[33.3%]为女性；3694[3.0%]为亚洲人，12611[10.1%]为黑人，12337[9.9%]为西班牙裔），20711 名（16.6%）患者被诊断为抑郁。与没有抑郁的患者相比，抑郁患者获得抗血小板药物（比值比[OR]，0.80；95%置信区间[CI]，0.77-0.85）、β 受体阻滞剂（OR，0.84；95%CI，0.80-0.88）和他汀类药物（OR，0.88；95%CI，0.85-0.93）充分 12 个月依从性的可能性显著降低；抑郁与肾素-血管紧张素-醛固酮系统抑制剂（OR，0.93；95%CI，0.85-1.00）的依从性无关联。抑郁患者也同样不太可能获得抗血小板药物、β 受体阻滞剂和他汀类药物以及肾素-血管紧张素-醛固酮系统抑制剂的最佳 12 个月依从性（OR，0.87；95%CI，0.82-0.94）。
在这项队列研究中，与没有抑郁的患者相比，抑郁患者经皮冠状动脉介入治疗后获得抗血小板药物、β 受体阻滞剂、他汀类药物和肾素-血管紧张素-醛固酮系统抑制剂等指南指导的医学治疗药物的充分或最佳依从性的可能性较低。认识到抑郁可能有助于针对药物依从性采取有针对性的干预措施，从而改善二级心血管疾病的预防。
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