Association of Depression and Adherence to Oral Anticoagulation in Patients With Atrial Fibrillation.
Association of Depression and Adherence to Oral Anticoagulation in Patients With Atrial Fibrillation.
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DOI：
10.1161/jaha.123.031281
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发表时间：
2023-11-20
影响因子：
5.4
通讯作者：
中科院分区：
文献类型：
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作者：
坚持口服抗凝药物对于预防心房颤动 (AF) 患者的卒中至关重要。抑郁症与多种疾病状态下药物依从性降低有关，而房颤患者中，抑郁症还与中风风险增加有关。我们假设患有抑郁症和房颤的个体比没有抑郁症的个体对抗凝治疗的依从性降低。我们使用行政索赔数据来识别 2013 年至 2019 年间开始使用直接口服抗凝剂 (DOAC) 或华法林进行抗凝治疗的房颤患者。我们使用覆盖天数比例来量化依从性，分类为有限（覆盖天数比例 <80%）、足够（覆盖天数比例 ≥80% 至 <90%）或最佳（覆盖天数比例≥90%）。我们在逻辑回归模型中将抑郁症与 12 个月坚持抗凝治疗联系起来，并根据人口统计数据、医疗和精神合并症、家庭收入、教育程度和保险类型进行调整。作为二次分析，我们确定了抑郁症与每种 DOAC 药物依从性的关联。我们确定了 101041 名开始使用 DOAC 或华法林的个体（年龄 74.5±8.9 岁；50.6% 为女性；29.5% 为白人以外的种族或族裔，包括亚洲人或黑人种族和西班牙裔）。抑郁症患者充分坚持 DOAC 的几率为 11%（95% CI，0.85-0.93），最佳坚持率比非抑郁症患者低 12%（95% CI，0.83-0.91）。抑郁症与坚持使用华法林无关。我们发现房颤患者的抑郁症与 DOAC 依从性下降之间存在关联，但与华法林无关。认识到 AF 中的抑郁症可能会指导干预措施，以提高抗凝依从性并降低中风风险。
Adherence to oral anticoagulation is essential for stroke prevention in atrial fibrillation (AF). Depression has been associated with decreased adherence to medications in multiple disease states and in AF is further associated with increased risk of stroke. We hypothesized that individuals with depression and AF have decreased adherence to anticoagulation than those without depression. We used administrative claims data to identify individuals with AF initiating anticoagulation with direct‐acting oral anticoagulants (DOACs) or warfarin between 2013 and 2019. We quantified adherence using proportion of days covered, categorized as limited (proportion of days covered, <80%), adequate (proportion of days covered, ≥80% to <90%), or optimal (proportion of days covered, ≥90%). We related depression to 12‐month adherence to anticoagulation in logistic regression models, adjusting for demographics, medical and psychiatric comorbidities, household income, educational attainment, and insurance type. As a secondary analysis, we determined the association of depression to adherence for each DOAC agent. We identified 101 041 individuals (aged 74.5±8.9 years; 50.6% women; 29.5% race or ethnicity other than White, including Asian or Black race and Hispanic ethnicity) who initiated either DOACs or warfarin. The odds of adequate adherence to DOACs was 11% (95% CI, 0.85–0.93), and the odds of optimal adherence was 12% (95% CI, 0.83–0.91) less in individuals with depression than those without. Depression was not associated with adherence to warfarin. We identified an association between depression and decreased adherence to DOACs but not warfarin in individuals with AF. Recognizing depression in AF may guide interventions to improve anticoagulation adherence and reduce stroke risk.
影响因子：
13.8
作者：
Lapa, Matthew E.;Swabe, Gretchen M.;Rollman, Bruce L.;Muldoon, Matthew F.;Thurston, Rebecca C.;Magnani, Jared W.
通讯作者：
Magnani, Jared W.