Impact of depression on medication non-adherence in coronary artery disease: a systematic review and meta-analysis
Dione Lorraine Jones1,2, Jason Yue3, Tu Ng Nguyen3
1Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia djon7752@uni.sydney.edu.au.
Insights
Depression in coronary artery disease (CAD) patients may increase medication non-adherence. Further research is needed due to significant heterogeneity in studies examining this link.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Depression is a significant risk factor and complication in patients with coronary artery disease (CAD).
- This association with depression can lead to poorer cardiovascular outcomes.
- Medication non-adherence is a potential mechanism linking depression and adverse cardiovascular events, with emerging evidence in this area.
Purpose of the Study:
- To assess the relationship between depression and medication adherence in patients diagnosed with coronary artery disease (CAD).
- To synthesize existing evidence on the prevalence of cardiovascular medication adherence in depressed versus non-depressed CAD patients.
Main Methods:
- A systematic literature search was conducted across Cochrane Library, Medline, and Embase databases up to January 2023.
- Included studies reported medication adherence rates in depressed vs. non-depressed adults (>18 years) with CAD (acute/chronic syndromes, post-PCI).
- A meta-analysis of 17 studies (82,059 patients) was performed to determine the odds ratio (OR) of non-adherence.
Main Results:
- Thirty studies were included, primarily cohort or cross-sectional, with most participants from the US.
- Prevalence of depression (1.7-76.6%) and medication non-adherence (5.9-72.9%) varied widely across studies.
- Meta-analysis indicated depression was associated with increased medication non-adherence (OR 1.48, 95% CI 1.23-1.78, p<0.001) via random effects model, but this was absent under a fixed effects model due to high heterogeneity (I²=91%).
Conclusions:
- Patients with CAD and co-occurring depression may face higher odds of medication non-adherence.
- Considerable clinical and statistical heterogeneity exists in the current research.
- Further investigation is crucial to elucidate the complex relationship between depression and medication adherence in CAD patients.
Background:
Depression is a risk factor and complication of coronary artery disease (CAD) that is associated with poor cardiovascular outcomes. This may be related to medication non-adherence; a topic on which considerable new evidence has emerged. We aim to assess the relationship between depression and medication adherence in patients with CAD.
Methods:
The Cochrane Library, Medline and Embase databases were searched for relevant studies published until January 2023. Studies were included if they reported the prevalence of adherence to cardiovascular medications in depressed versus non-depressed participants aged >18 years with CAD, including acute and chronic coronary syndromes and those undergoing percutaneous coronary intervention. The primary outcome was the OR of non-adherence to cardiovascular medications in depressed versus non-depressed patients.
Results:
Included studies (n=30) comprised mainly of cohort or cross-sectional studies, most of which involved US participants. Nine tools were used to measure medication adherence, the majority of which relied on participant self-report. Nine depression diagnostic tools were used, including the Patient Health Questionnaire, Beck Depression Inventory and International Classification of Diseases (ICD-9/10) diagnostic codes. The prevalence of depression ranged widely (1.7-76.6%), as did medication non-adherence (5.9-72.9%). A meta-analysis of 17 studies and 82 059 patients showed that depression was associated with increased medication non-adherence (OR 1.48, 95% CI 1.23 to 1.78, p<0.001) using a random effects model. However, there was considerable heterogeneity between studies (I2=91%, τ2=0.17, p<0.001), and the association was absent under a fixed effects model (OR 0.99 95% CL 0.98 to 1.01, p=0.58).
Conclusion:
Patients with CAD and depression may have increased odds of medication non-adherence; however, there was considerable clinical and statistical heterogeneity, underscoring the need for further research to better understand this relationship.
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