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Cardiovascular hazards of insufficient treatment of depression among patients with known cardiovascular disease: a propensity score adjusted analysis
Aims
The association between depression care adequacy and the risk of subsequent adverse cardiovascular disease (CVD) outcomes among patients with a previous diagnosis of myocardial infarction (MI) or stroke is not well defined.
Methods and Results
This retrospective cohort study used commercial claims data (2010-2015) and included adults with newly diagnosed and treated MDD following an initial MI or stroke diagnosis. Depression care adequacy was assessed during the 3-month period following the MDD diagnosis index date using two measures: antidepressant dosage adequacy and duration adequacy. Cox models adjusted for the propensity of receiving adequate depression care were used to compare the risk of a composite CVD outcome (MI, stroke, congestive heart failure [CHF], and angina) as well as each individual CVD event between patients receiving adequate versus inadequate depression care. 1568 patients were included in the final cohort. Of these, 937 (59.8%) were categorized as receiving inadequate depression care based on at least 1 of the 2 treatment adequacy criteria. Propensity score adjusted Cox models showed that depression care inadequacy was associated with a significantly higher risk of the composite CVD endpoint (HR, 1.20; 95% CI, 1.04-1.39), stroke (HR 1.20, 95% CI, 1.02-1.42) and angina (HR 1.95, 95% CI, 1.21-3.16) with no significant interaction based on cohort included (MI vs. stroke) or the definition of inadequate depression (dose vs. duration inadequacy) (Pinteraction>0.05).
Conclusions
Inadequate MDD care was associated with a higher risk of adverse CVD events. These findings reveal a significant unmet clinical need in patients with post-MI or post-stroke MDD that may impact CVD outcomes.
Authors
S Bangalore, R Shah, E Pappadopulos, C G Deshpande, A Shelbaya, R Prieto, J Stephens, R S McIntyre
Journal
European Health Journal Quality of Care and Clinical Outcomes
Therapeutic Area
Cardiology
Center of Excellence
Real-world Evidence & Data Analytics
Year
2018
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