Adherence to antidepressant therapy and mortality rates in ischaemic heart disease: cohort study
Amir Krivoy1, Ran D Balicer1, Becca Feldman1
1Amir Krivoy, MD, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Ran D. Balicer, MD, PhD, Clalit Research Institute, Tel Aviv, Public Health Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva; Becca Feldman, PhD, Moshe Hoshen, PhD, Clalit Research Institute, Tel Aviv, Israel; Gil Zalsman, MD, MHA, Geha Mental Health Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, USA; Abraham Weizman, MD, Geha Mental Health Center, Petah Tiqva, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Gal Shoval, MD, Clalit Research Institute, Tel Aviv, Geha Mental Health Center, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Adherence to antidepressant therapy significantly reduces mortality risk in patients with ischaemic heart disease (IHD). Improving adherence to antidepressant medications is crucial for better outcomes in IHD patients.
Area of Science:
- Cardiology
- Psychiatry
- Pharmacology
Background:
- The impact of antidepressant drugs on mortality in patients with ischaemic heart disease (IHD) remains unclear due to limited and conflicting data.
- Previous research has not definitively established the relationship between antidepressant use and mortality in this vulnerable population.
Purpose of the Study:
- To investigate the association between adherence to antidepressant therapy and all-cause mortality.
- To analyze this relationship in a large, population-based cohort of patients diagnosed with IHD.
Main Methods:
- A retrospective cohort study included 63,437 patients with IHD who purchased antidepressants between 2008-2011.
- Patient adherence was categorized as non-adherence (<20%), poor (20-50%), moderate (50-80%), and good (>80%) based on medication claims versus prescriptions.
- Multivariable survival analyses were employed, adjusting for potential confounding demographic and clinical factors.
Main Results:
- Patients with moderate adherence (50-80%) showed a significantly reduced adjusted mortality hazard ratio of 0.83 (95% CI 0.78-0.88).
- Good adherence (>80%) was also associated with a significantly reduced adjusted mortality hazard ratio of 0.86 (95% CI 0.82-0.90).
- Both moderate and good adherence levels demonstrated a protective effect against all-cause mortality compared to non-adherence.
Conclusions:
- Adherence to antidepressant pharmacotherapy is linked to a lower risk of all-cause mortality in patients with IHD.
- Healthcare providers and policymakers should prioritize strategies to improve and maintain antidepressant adherence in this patient group.
- Enhanced adherence may be a key modifiable factor for improving survival outcomes in patients with IHD.
Background:
The use of antidepressant drugs in patients with ischaemic heart disease (IHD) has been debated owing to scarcity of data and conflicting results regarding the effect of these drugs on mortality.
Aims:
To evaluate the association between adherence to antidepressant therapy and all-cause mortality in a population-based cohort of patients with IHD.
Method:
A total of 63 437 patients with IHD who purchased antidepressants at least once during the years 2008-2011 were retrospectively followed for all-cause mortality over 4 years. Adherence was measured as a ratio between claimed and prescribed durations of medication and modelled as non-adherence (<20%), poor (20-50%), moderate (50-80%) and good (>80%). We used multivariable survival analyses adjusted for demographic and clinical variables that may affect mortality.
Results:
The moderate and good adherence groups had significantly reduced adjusted mortality hazard ratios of 0.83 (95% CI 0.78-0.88) and 0.86 (95% CI 0.82-0.90) respectively, compared with the non-adherence group.
Conclusions:
Adherence to antidepressant pharmacotherapy is associated with reduced all-cause mortality in a population-based large sample cohort of patients with IHD. Physicians and health policy decision-makers should step up their efforts to sustain and enhance these patients' adherence to their antidepressant regimen.