Inadequate treatment of depression in CVD may confer worse outcomes

Sripal Bangalore

ORLANDO, Fla. — Among patients with CVD and major depressive disorder, those whose depression was not adequately treated had worse CV outcomes, according to a retrospective cohort study presented at the American College of Cardiology Scientific Session.

Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, associate professor of medicine, director of research of the cardiac catheterization laboratory and director of the Cardiovascular Outcomes Group in the Cardiovascular Clinical Research Center at NYU Langone Health, and colleagues analyzed 1,568 patients from a claims database diagnosed with major depressive disorder after an MI or stroke between 2010 and 2015.

“Cardiologists don’t do a good job of recognizing depression, so increasing awareness is extremely important,” Bangalore told Cardiology Today. “After an MI or stroke, there is a risk for many of our patients that they will go into depression, which can have many consequences. We wanted to look at the impact of recognition and adequacy of treatment of depression, and how it relates to cardiovascular outcomes. We found that inadequate treatment of depression after a major event like MI or stroke is associated with recurrence of cardiovascular events, which means that it has implications for cardiovascular practice and the economics of cardiovascular care.”

Patients were stratified by whether they received adequate care for depression, defined as dosage adequacy (equivalent dose of 20 mg per day of fluoxetine for nonelderly patients and equivalent dose of 10 mg per day of fluoxetine for elderly patients) and duration adequacy (coverage of a drug to treat major depressive order for at least 72 of the 90 days after depression diagnosis).

The 59.8% of patients who received inadequate care for depression were compared with the 41.2% of patients who received adequate care for a composite outcome of MI, stroke, congestive HF and angina, as well as each of those outcomes individually.

Bangalore, a member of the Cardiology Today Editorial Board, and colleagues found that after adjustment, those with inadequate care for depression had higher risk for the composite outcome (HR = 1.2; 95% CI, 1.04-1.39), stroke (HR = 1.2; 95% CI, 1.02-1.42) and angina (HR = 1.95; 95% CI, 1.21-3.16) compared with those who had adequate care for depression.

The researchers also found those with inadequate care had a numerically higher risk for MI (HR = 1.37; 95% CI, 0.8-2.33) and congestive HF (HR = 1.14; 95% CI, 0.91-1.42).

“While we did not look at the actual screening for depression, we should all be aware that patients with CVD should be screened for depression,” Bangalore said in an interview. “Once there is a diagnosis of depression, adequate treatment through multidisciplinary care is needed. We need more awareness of this issue, as it is not really mentioned in the guidelines.”
– by Erik Swain

Reference:

Bangalore S, et al. Abstract 1303-419. Presented at: American College of Cardiology Scientific Session; March 10-12, 2018; Orlando, Fla.

Disclosure: Bangalore reports no relevant financial disclosures.