Non-adherence to cardiovascular drugs in older patients with depression: A population-based cohort study

Floor Holvast, Hans Wouters, Karin Hek, François Schellevis, Richard Oude Voshaar, Liset van Dijk, Huibert Burger, Peter Verhaak

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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.
LanguageEnglish
Pages366-371
JournalInternational Journal of Cardiology
Volume274
DOIs
StatePublished - 2019

Cite this

Holvast, Floor ; Wouters, Hans ; Hek, Karin ; Schellevis, François ; Oude Voshaar, Richard ; van Dijk, Liset ; Burger, Huibert ; Verhaak, Peter. / Non-adherence to cardiovascular drugs in older patients with depression: A population-based cohort study. In: International Journal of Cardiology. 2019 ; Vol. 274. pp. 366-371
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title = "Non-adherence to cardiovascular drugs in older patients with depression: A population-based cohort study",
abstract = "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.",
author = "Floor Holvast and Hans Wouters and Karin Hek and Fran{\cc}ois Schellevis and {Oude Voshaar}, Richard and {van Dijk}, Liset and Huibert Burger and Peter Verhaak",
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Holvast, F, Wouters, H, Hek, K, Schellevis, F, Oude Voshaar, R, van Dijk, L, Burger, H & Verhaak, P 2019, 'Non-adherence to cardiovascular drugs in older patients with depression: A population-based cohort study' International Journal of Cardiology, vol. 274, pp. 366-371. DOI: 10.1016/j.ijcard.2018.08.100

Non-adherence to cardiovascular drugs in older patients with depression: A population-based cohort study. / Holvast, Floor; Wouters, Hans; Hek, Karin; Schellevis, François; Oude Voshaar, Richard; van Dijk, Liset; Burger, Huibert; Verhaak, Peter.

In: International Journal of Cardiology, Vol. 274, 2019, p. 366-371.

Research output: Contribution to journalArticleAcademicpeer-review

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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

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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.

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