Coronary artery disease
Effects of Depression and Anxiety Improvement on Adherence to Medication and Health Behaviors in Recently Hospitalized Cardiac Patients

https://doi.org/10.1016/j.amjcard.2011.12.017Get rights and content

Impaired adherence to medications and health behaviors may mediate the connection between psychiatric symptoms and mortality in cardiac patients. This study assessed the association between improvements in depression/anxiety and self-reported adherence to health behaviors in depressed cardiac patients in the 6 months after cardiac hospitalization. Data were analyzed from depressed patients on inpatient cardiac units who were hospitalized for acute coronary syndrome, heart failure, or arrhythmia and enrolled in a randomized trial of collaborative care depression management (n = 134 in primary analysis). Measurements of depression (Patient Health Questionnaire-9), anxiety (Hospital Anxiety and Depression Scale, Anxiety subscale), and adherence to secondary prevention behaviors (Medical Outcomes Study-Specific Adherence Scale items) were obtained at baseline, 6 weeks 12 weeks, and 6 months. The association between improvement in depression/anxiety and adherence was assessed by linear regression after accounting for the effects of multiple relevant covariates. At all time points improvement in the Patient Health Questionnaire-9 was significantly and independently associated with self-reported adherence to medications and secondary prevention behaviors. In contrast, improvement in the Hospital Anxiety and Depression Scale, Anxiety subscale was associated with improved adherence only at 6 weeks. In conclusion, in a cohort of depressed cardiac patients, improvement in depression was consistently and independently associated with superior self-reported adherence to medications and secondary prevention behaviors across a 6-month span, whereas improvement in anxiety was not.

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Methods

This was a secondary analysis from a prospective randomized trial (http://clinicaltrials.gov, identifier NCT00847132) of a 12-week collaborative care depression treatment program versus usual care for depressed patients admitted to inpatient cardiac units.9 All study procedures were approved by the hospital's institutional review board.

Eligible patients for the collaborative care study were admitted for ACS, decompensated heart failure, or arrhythmia to inpatient cardiac units at an urban

Results

One hundred seventy-five participants enrolled in the trial; 14 subjects (8.0%) died during the 6-month study period. Of the 161 surviving patients, 134 (83.2%) completed all portions of the 6-month follow-up evaluation and were included in the primary analysis. Of these 134 subjects, 70 (52.2%) were randomized to the collaborative care intervention and 64 (47.8%) to usual care. Baseline characteristics of these 134 subjects are listed in Table 1. There were no significant differences on any

Discussion

Our results are consistent with previous findings that depression is associated with impaired subsequent adherence behavior (e.g., medication adherence, heart-healthy diet) in cardiac patients.5, 15 However, to our knowledge, only 2 previous studies have assessed whether improvement of depression is associated with improved adherence to cardiac treatment.

First, a pair of reports by Rieckmann et al25, 26 from 1 study found that improvement of depression (assessed during hospitalization and 3

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    Dr Huffman received Scientist Development Grant 0735530T from the American Heart Association.

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