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.
Holvast, F., Wouters, H., Hek, K., Schellevis, F., Oude Voshaar, R., van Dijk, L., ... Verhaak, P. (2019). Non-adherence to cardiovascular drugs in older patients with depression: A population-based cohort study. International Journal of Cardiology, 274, 366-371. https://doi.org/10.1016/j.ijcard.2018.08.100