Depression Linked to Adherence to Guideline-Directed Medical Therapy After PCI

Following percutaneous coronary intervention (PCI), patients with depression are less likely to attain adequate or optimal adherence to medications essential to guideline-directed medical therapies (GDMTs), according to the results of a retrospective cohort study published in JAMA Network Open.

Recognizing that adherence to GDMTs is critical for the secondary prevention of cardiovascular disease, researchers sought to evaluate the association between depression and 12-month adherence to GDMTs (antiplatelet agents, beta-blockers, renin-angiotensin-aldosterone system (RAAS) inhibitors, and statins) in patients receiving PCI.

All study participants received PCI between January 1, 2014, and December 31, 2019. All data for the analysis were obtained from a large US health claims database and reviewed from February 2022 to August 2022. A diagnosis of depression was identified as that occurring during the 12 months of enrollment prior to PCI or within 6 months after PCI.

Medication adherence was evaluated using proportion of days covered (PDC), which was calculated as the ratio of the number of days a medication is available and the number of follow-up observation days. Medication discontinuation per PDC is defined by a period of 60 days or longer without available medication. 

Twelve-month adherence was categorized as adequate (PDC ≥80% to <90%) or optimal (PDC ≥90%). The investigators theorized that patients with depression would exhibit a lower likelihood of either adequate or optimal adherence to medications that are essential for GDMT.

A total of 124,443 individuals who received PCI were included in the analysis. Overall, 33.3% of the participants were women, 10.1% were Black, 9.9% were Hispanic, and 3.0% were Asian. The mean patient age was 69.3 (SD, 10.6) years. In all, 72.2% of the patients received Medicare. The median number of GDMT classes of medication used was 3 (range, 3 to 4).

Results of the study showed that 16.6% of the participants had a diagnosis of depression. Individuals with depression were significantly less likely to obtain adequate 12-month adherence to antiplatelet agents (odds ratio [OR], 0.80; 95% CI, 0.77-0.85), beta-blockers (OR, 0.84; 95% CI, 0.80-0.88), and statins (OR, 0.88; 95% CI, 0.85-0.93) than were participants without depression. No association was reported between depression and adherence to RAAS inhibitors (OR, 0.93; 95% CI, 0.85-1.00).

Additionally, individuals with depression had a similarly decreased likelihood of optimal 12-month adherence to antiplatelet agents, beta-blockers, and statins, as well as to RAAS inhibitors (OR, 0.87; 95% CI, 0.82-0.94).

There are several limitations of the study. As only individuals with insurance were included in the analysis, the results may not be generalizable to those without insurance. Further, the possibility of misclassification of depression status exists because of the reliance of the claims data on ICD coding. Since adherence was established based on records of prescription fills, it is not reflective of patients’ daily use of medications.

“Further studies are needed to determine whether treatment of depression may improve medication adherence as well as how such treatment improves secondary prevention of cardiovascular disease,” the researchers wrote.

Disclosure: One of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.