TY - JOUR
T1 - Non-adherence to cardiovascular drugs in older patients with depression: A population-based cohort study
AU - Holvast, Floor
AU - Wouters, Hans
AU - Hek, Karin
AU - Schellevis, François
AU - Oude Voshaar, Richard
AU - van Dijk, Liset
AU - Burger, Huibert
AU - Verhaak, Peter
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background: Depression is common among patients with cardiovascular disease and has been associated with both drug non-adherence and increased mortality. Non-adherence can occur because of non-initiation, suboptimal implementation, or non-persistence. We aimed to determine if depression increased the risk of any of these components of non-adherence among older patients prescribed cardiovascular drugs in primary care. Methods: A longitudinal analysis of routine primary care data from the Nivel Primary Care Database was performed using data for 2011–2013. A total of 1512 patients aged ≥60 years diagnosed with depression in 2012 were compared with age- and sex-matched groups with either other psychological diagnoses (N = 1457) or mentally healthy controls (N = 1508), resulting in the inclusion of 4477 patients. Non-adherence was classified as non-initiation, suboptimal implementation, or non-persistence. Regression analyses were performed to determine the association between mental health status and non-initiation, suboptimal implementation, and non-persistence. Results: Mixed-effects logistic regression analyses showed increased odds for suboptimal implementation of beta-blockers among depressed patients (2.18; 95% CI 1.29–3.69). For non-persistence, a clustered Cox regression analysis demonstrated that, compared with controls, there was an increased hazard ratio for depressed patients to discontinue beta-blockers (2.31; 95% CI 1.58–3.37) and calcium antagonists (1.74; 95% CI 1.23–2.46). Conclusions: It is likely that older patients in primary care diagnosed with depression are at increased risk of non-persistence with cardiovascular drug therapy. Because non-adherence is associated with increased cardiovascular mortality, it is important that physicians ensure that older depressed patients persevere with therapy.
AB - Background: Depression is common among patients with cardiovascular disease and has been associated with both drug non-adherence and increased mortality. Non-adherence can occur because of non-initiation, suboptimal implementation, or non-persistence. We aimed to determine if depression increased the risk of any of these components of non-adherence among older patients prescribed cardiovascular drugs in primary care. Methods: A longitudinal analysis of routine primary care data from the Nivel Primary Care Database was performed using data for 2011–2013. A total of 1512 patients aged ≥60 years diagnosed with depression in 2012 were compared with age- and sex-matched groups with either other psychological diagnoses (N = 1457) or mentally healthy controls (N = 1508), resulting in the inclusion of 4477 patients. Non-adherence was classified as non-initiation, suboptimal implementation, or non-persistence. Regression analyses were performed to determine the association between mental health status and non-initiation, suboptimal implementation, and non-persistence. Results: Mixed-effects logistic regression analyses showed increased odds for suboptimal implementation of beta-blockers among depressed patients (2.18; 95% CI 1.29–3.69). For non-persistence, a clustered Cox regression analysis demonstrated that, compared with controls, there was an increased hazard ratio for depressed patients to discontinue beta-blockers (2.31; 95% CI 1.58–3.37) and calcium antagonists (1.74; 95% CI 1.23–2.46). Conclusions: It is likely that older patients in primary care diagnosed with depression are at increased risk of non-persistence with cardiovascular drug therapy. Because non-adherence is associated with increased cardiovascular mortality, it is important that physicians ensure that older depressed patients persevere with therapy.
KW - Aged
KW - Cardiovascular drugs
KW - Depression
KW - Non-adherence
KW - Primary health care
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85053704613&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30249352
U2 - https://doi.org/10.1016/j.ijcard.2018.08.100
DO - https://doi.org/10.1016/j.ijcard.2018.08.100
M3 - Article
C2 - 30249352
SN - 0167-5273
VL - 274
SP - 366
EP - 371
JO - International journal of cardiology
JF - International journal of cardiology
ER -