학술논문
Cardiovascular hazards of insufficient treatment of depression among patients with known cardiovascular disease: a propensity score adjusted analysis.
Document Type
Academic Journal
Author
Bangalore S; Cardiovascular Outcomes Group, Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 First Avenue, SKI 9R/109, New York, NY, USA.; Shah R; Pharmerit International, LP, 4350 East West Hwy, Suite #1110, Bethesda, MD, USA.; Pappadopulos E; Pfizer Inc., 235 E 42nd St, New York, NY, USA.; Deshpande CG; Pharmerit International, LP, 4350 East West Hwy, Suite #1110, Bethesda, MD, USA.; Shelbaya A; Pfizer Inc., 235 E 42nd St, New York, NY, USA.; Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, USA.; Prieto R; Pfizer GEP, S.L.U., AVENIDA DE EUROPA (PQ EMP LA MORALEJA), 20 - B, ALCOBENDAS, MADRID, Spain.; Stephens J; Pharmerit International, LP, 4350 East West Hwy, Suite #1110, Bethesda, MD, USA.; McIntyre RS; MDPU, UHN University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, Ontario, Canada.; Brain and Cognition Discovery Foundation, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, Ontario, Canada.
Source
Publisher: Oxford University Press Country of Publication: England NLM ID: 101677796 Publication Model: Print Cited Medium: Internet ISSN: 2058-1742 (Electronic) Linking ISSN: 20581742 NLM ISO Abbreviation: Eur Heart J Qual Care Clin Outcomes Subsets: MEDLINE
Subject
Language
English
Abstract
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 major depressive disorder (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, and angina) as well as each individual CVD event between patients receiving adequate vs. inadequate depression care. A total of 1568 patients were included in the final cohort. Of these, 937 (59.8%) were categorized as receiving inadequate depression care based on at least one of the two 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 [hazard ratio (HR) 1.20, 95% confidence interval (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).
Conclusion: 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.
Methods and Results: This retrospective cohort study used commercial claims data (2010-2015) and included adults with newly diagnosed and treated major depressive disorder (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, and angina) as well as each individual CVD event between patients receiving adequate vs. inadequate depression care. A total of 1568 patients were included in the final cohort. Of these, 937 (59.8%) were categorized as receiving inadequate depression care based on at least one of the two 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 [hazard ratio (HR) 1.20, 95% confidence interval (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).
Conclusion: 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.