Assessment of Depression and Adherence to Guideline-Directed Medical Therapies Following Percutaneous Coronary Intervention.
Assessment of Depression and Adherence to Guideline-Directed Medical Therapies Following Percutaneous Coronary Intervention.
复制标题
经皮冠状动脉介入治疗后抑郁和对指南指导药物治疗依从性的评估。
DOI：
10.1001/jamanetworkopen.2022.46317
复制
发表时间：
2022-12-01
影响因子：
13.8
通讯作者：
Magnani, Jared W.
中科院分区：
文献类型：
--
作者：
Lapa, Matthew E.;Swabe, Gretchen M.;Rollman, Bruce L.;Muldoon, Matthew F.;Thurston, Rebecca C.;Magnani, Jared W.
经皮冠状动脉介入治疗后抑郁与遵医嘱治疗有何关联？在这项对124 443名接受经皮冠状动脉介入治疗的患者进行的队列研究中，抑郁症患者比无抑郁症患者在12个月内达到最佳依从性的可能性低10%至20%。在调整了人口统计学特征、共病医学和精神疾病、社会因素（教育和收入）和药物调整后，这些结果仍然存在。这些发现表明，筛查和解决心血管疾病患者的抑郁症对于制定有针对性的策略来改善抑郁症患者的药物依从性和加强二级心血管预防至关重要。本队列研究评估了经皮冠状动脉介入治疗（PCI）后12个月坚持指南指导的药物治疗与抑郁症的关系。抑郁症与原发性和继发性心血管事件的风险增加有关。药物依从性可能起着至关重要的作用。评估经皮冠状动脉介入治疗后12个月依从指南药物治疗（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）与抑郁症的关系。这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。数据是从美国一个大型健康声明数据库中收集的，并在2022年2月至8月期间进行了分析。指南指导的药物治疗类别的覆盖天数比例（PDC）， 12个月的依从性被分类为适当（PDC≥80%至<90%）或最佳（PDC≥90%）。采用多变量调整回归模型评估抑郁与依从性的关系；模型纳入了人口统计学特征、共病医学和精神疾病、抑郁症治疗和指导方针指导的药物治疗调整。假设是，抑郁症患者在适当或最佳地坚持指导指导的药物治疗方面的几率较低。在接受经皮冠状动脉介入治疗的124 443例患者（平均[SD]年龄69.3[10.6]岁，女性41 430[33.3%]，亚洲人3694[3.0%]，黑人12 611[10.1%]，西班牙裔12 337[9.9%]）中，有20 711例（16.6%）被诊断为抑郁症。与没有抑郁症的患者相比，抑郁症患者获得足够的12个月坚持服用抗血小板药物（比值比[OR]， 0.80; 95% 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）的可能性显著降低；抑郁与坚持使用肾素-血管紧张素-醛固酮系统抑制剂之间没有关联（OR, 0.93; 95% CI, 0.85-1.00）。抑郁症患者12个月坚持使用抗血小板、β受体阻滞剂、他汀类药物以及肾素-血管紧张素-醛固酮系统抑制剂的可能性也同样降低（OR, 0.87; 95% CI, 0.82-0.94）。在这项队列研究中，与没有抑郁症的患者相比，抑郁症患者在经皮冠状动脉介入治疗后不太可能达到充分或最佳的药物依从性。认识到抑郁症可能有助于有针对性的干预措施，以解决药物依从性问题，从而改善继发性心血管疾病的预防。
What is the association between depression and adherence to guideline-directed medical therapies following percutaneous coronary intervention? In this cohort study of 124 443 individuals who underwent percutaneous coronary intervention, those with depression were approximately 10% to 20% less likely to achieve 12-month optimal adherence to guideline-directed medical therapies than those without depression. These results persisted following adjustment for demographic characteristics, comorbid medical and psychiatric conditions, social factors (education and income), and medication adjustment. These findings suggest that screening for and addressing depression in those with cardiovascular disease are essential for developing targeted strategies to improve medication adherence and enhance secondary cardiovascular prevention in individuals with depression. This cohort study evaluates the association of depression with 12-month adherence to guideline-directed medical therapies following percutaneous coronary intervention (PCI). 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. 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.
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影响因子：
4.8
作者：
Mathews R;Wang TY;Honeycutt E;Henry TD;Zettler M;Chang M;Fonarow GC;Peterson ED;TRANSLATE-ACS Study Investigators
通讯作者：
TRANSLATE-ACS Study Investigators
影响因子：
5.9
作者：
Naderi, Sayed H.;Bestwick, Jonathan P.;Wald, David S.
通讯作者：
Wald, David S.
影响因子：
5.7
作者：
LaRosa, Anna Rose;Claxton, J'Neka;Magnani, Jared W.
通讯作者：
Magnani, Jared W.
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
37.8
作者：
Magnani, Jared W.;Mujahid, Mahasin S.;Willey, Joshua Z.
通讯作者：
Willey, Joshua Z.