Association of Depression and Adherence to Oral Anticoagulation in Patients With Atrial Fibrillation
Background Adherence to oral anticoagulation is essential for stroke prevention in atrial fibrillation (AF). Depression has been associated with decreased adherence to medications in multiple disease states and in AF is further associated with increased risk of stroke. We hypothesized that individua...
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| Format: | Article |
| Language: | English |
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Wiley
2023-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.031281 |
| _version_ | 1797540968895873024 |
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| author | Matthew E. Lapa Gretchen M. Swabe Jared W. Magnani |
| author_facet | Matthew E. Lapa Gretchen M. Swabe Jared W. Magnani |
| author_sort | Matthew E. Lapa |
| collection | DOAJ |
| description | Background Adherence to oral anticoagulation is essential for stroke prevention in atrial fibrillation (AF). Depression has been associated with decreased adherence to medications in multiple disease states and in AF is further associated with increased risk of stroke. We hypothesized that individuals with depression and AF have decreased adherence to anticoagulation than those without depression. Methods and Results We used administrative claims data to identify individuals with AF initiating anticoagulation with direct‐acting oral anticoagulants (DOACs) or warfarin between 2013 and 2019. We quantified adherence using proportion of days covered, categorized as limited (proportion of days covered, <80%), adequate (proportion of days covered, ≥80% to <90%), or optimal (proportion of days covered, ≥90%). We related depression to 12‐month adherence to anticoagulation in logistic regression models, adjusting for demographics, medical and psychiatric comorbidities, household income, educational attainment, and insurance type. As a secondary analysis, we determined the association of depression to adherence for each DOAC agent. We identified 101 041 individuals (aged 74.5±8.9 years; 50.6% women; 29.5% race or ethnicity other than White, including Asian or Black race and Hispanic ethnicity) who initiated either DOACs or warfarin. The odds of adequate adherence to DOACs was 11% (95% CI, 0.85–0.93), and the odds of optimal adherence was 12% (95% CI, 0.83–0.91) less in individuals with depression than those without. Depression was not associated with adherence to warfarin. Conclusions We identified an association between depression and decreased adherence to DOACs but not warfarin in individuals with AF. Recognizing depression in AF may guide interventions to improve anticoagulation adherence and reduce stroke risk. |
| first_indexed | 2024-03-10T13:09:36Z |
| format | Article |
| id | doaj.art-548c6e64876f447b911457bbcf005298 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-10T13:09:36Z |
| publishDate | 2023-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-548c6e64876f447b911457bbcf0052982023-11-21T10:53:12ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-11-01122210.1161/JAHA.123.031281Association of Depression and Adherence to Oral Anticoagulation in Patients With Atrial FibrillationMatthew E. Lapa0Gretchen M. Swabe1Jared W. Magnani2University of Pittsburgh School of Medicine Pittsburgh PAUniversity of Pittsburgh School of Medicine Pittsburgh PADepartment of Medicine University of Pittsburgh Pittsburgh PABackground Adherence to oral anticoagulation is essential for stroke prevention in atrial fibrillation (AF). Depression has been associated with decreased adherence to medications in multiple disease states and in AF is further associated with increased risk of stroke. We hypothesized that individuals with depression and AF have decreased adherence to anticoagulation than those without depression. Methods and Results We used administrative claims data to identify individuals with AF initiating anticoagulation with direct‐acting oral anticoagulants (DOACs) or warfarin between 2013 and 2019. We quantified adherence using proportion of days covered, categorized as limited (proportion of days covered, <80%), adequate (proportion of days covered, ≥80% to <90%), or optimal (proportion of days covered, ≥90%). We related depression to 12‐month adherence to anticoagulation in logistic regression models, adjusting for demographics, medical and psychiatric comorbidities, household income, educational attainment, and insurance type. As a secondary analysis, we determined the association of depression to adherence for each DOAC agent. We identified 101 041 individuals (aged 74.5±8.9 years; 50.6% women; 29.5% race or ethnicity other than White, including Asian or Black race and Hispanic ethnicity) who initiated either DOACs or warfarin. The odds of adequate adherence to DOACs was 11% (95% CI, 0.85–0.93), and the odds of optimal adherence was 12% (95% CI, 0.83–0.91) less in individuals with depression than those without. Depression was not associated with adherence to warfarin. Conclusions We identified an association between depression and decreased adherence to DOACs but not warfarin in individuals with AF. Recognizing depression in AF may guide interventions to improve anticoagulation adherence and reduce stroke risk.https://www.ahajournals.org/doi/10.1161/JAHA.123.031281adherenceanticoagulationatrial fibrillationdepression |
| spellingShingle | Matthew E. Lapa Gretchen M. Swabe Jared W. Magnani Association of Depression and Adherence to Oral Anticoagulation in Patients With Atrial Fibrillation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease adherence anticoagulation atrial fibrillation depression |
| title | Association of Depression and Adherence to Oral Anticoagulation in Patients With Atrial Fibrillation |
| title_full | Association of Depression and Adherence to Oral Anticoagulation in Patients With Atrial Fibrillation |
| title_fullStr | Association of Depression and Adherence to Oral Anticoagulation in Patients With Atrial Fibrillation |
| title_full_unstemmed | Association of Depression and Adherence to Oral Anticoagulation in Patients With Atrial Fibrillation |
| title_short | Association of Depression and Adherence to Oral Anticoagulation in Patients With Atrial Fibrillation |
| title_sort | association of depression and adherence to oral anticoagulation in patients with atrial fibrillation |
| topic | adherence anticoagulation atrial fibrillation depression |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.031281 |
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