Depression and Adherence to DOACs in AF Patients

Depression may lower adherence to DOACs among AF patients suggests a new study published in the Journal of the American Heart Association.

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.

They 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%)
• 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.

They 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.

Reference:

Association of Depression and Adherence to Oral Anticoagulation in Patients With Atrial Fibrillation. Matthew E. Lapa, Gretchen M. Swabe and Jared W. Magnani
Originally published 20 Nov 2023 https://doi.org/10.1161/JAHA.123.031281
Journal of the American Heart Association. 2023;12:e031281

Keywords:

• Depression
• May
• Lower
• Adherence
• DOACs
• Among
• AF
• Patients
• Journal of the American Heart Association
• Matthew E. Lapa
• Gretchen M. Swabe
• Jared W. Magnani