Persistent depression affects adherence to secondary prevention behaviors after acute coronary syndromes

Abstract

BACKGROUND: The persistence of depressive symptoms after hospitalization is a strong risk factor for mortality after acute coronary syndromes (ACS). Poor adherence to secondary prevention behaviors may be a mediator of the relationship between depression and increased mortality. OBJECTIVE: To determine whether rates of adherence to risk reducing behaviors were affected by depressive status during hospitalization and 3 months later. DESIGN: Prospective observational cohort study. SETTING: Three university hospitals. PARTICIPANTS: Five hundred and sixty patients were enrolled within 7 days after ACS. Of these, 492 (88%) patients completed 3‐month follow‐up. MEASUREMENTS: We used the Beck Depression Inventory (BDI) to assess depressive symptoms in the hospital and 3 months after discharge. We assessed adherence to 5 risk‐reducing behaviors by patient self‐report at 3 months. We used χ2 analysis to compare differences in adherence among 3 groups: persistently nondepressed (BDI <10 at hospitalization and 3 months); remittent depressed (BDI ≥10 at hospitalization; <10 at 3 months); and persistently depressed patients (BDI ≥10 at hospitalization and 3 months). RESULTS: Compared with persistently nondepressed, persistently depressed patients reported lower rates of adherence to quitting smoking (adjusted odds ratio [OR] 0.23, 95% confidence interval [95% CI] 0.05 to 0.97), taking medications (adjusted OR 0.50, 95% CI 0.27 to 0.95), exercising (adjusted OR 0.57, 95% CI 0.34 to 0.95), and attending cardiac rehabilitation (adjusted OR 0.5, 95% CI 0.27 to 0.91). There were no significant differences between remittent depressed and persistently nondepressed patients. CONCLUSIONS: Persistently depressed patients were less likely to adhere to behaviors that reduce the risk of recurrent ACS. Differences in adherence to these behaviors may explain in part why depression predicts mortality after ACS.

Anger and depression predict hospital use among chronic heart failure patients

“…26 Depression among coronary heart disease patients is also associated with non-adherence to risk-reducing behaviours such as exercise, cessation of smoking and attendance at a cardiac rehabilitation program. 27 Non-adherence to these behaviours may worsen health and thus increase readmissions.…”

The association among depressive symptoms, smoking status and antidepressant use in cardiac outpatients

“…For example, continued smoking in CAD patients is associated with non-fatal myocardial infarctions, recurrent coronary events, the lowering of high-density lipoprotein cholesterol, restenosis and all-cause mortality (Critchley and Capewell, 2004;Rea et al, 2002;Johansson et al, 1985;Ronnevik et al, 1985;Salonen et al, 1980;Wilson et al, 2000;Perkins and Dick, 1985;Kinjo et al, 2005;Serrano et al, 2003;Kwiterovich et al, 1998). Previous studies show that approximately 14-37% of the cardiac population are current smokers (Attebring et al, 2004;Hasdai et al, 1997;Huijbrechts et al, 1996;Kronish et al, 2006;Taira et al, 2000).…”

“…Some of these characteristics include weight gain (Blitzer, Rimm, and Giefer, 1977;Cordoba et al, 1994;Detry et al, 2001;Grunberg, Bowen, and Winders, 1986;Wack and Rodin, 1982) and insomnia (Underner, 2006;Colrain, 2004) after quit attempts, personal and sociodemographic factors (Bjornson et al, 1995;Blake et al, 1989;Pomerleau, Pomerleau, and Garcia, 1991;Rosal et al, 1998;Royce et al, 1997;van Berkel et al, 1999;Waldron, 1991), history of a cardiac event (Attebring et al, 2004), hostility, tension and depressive symptoms (Perez et al, 2008;Brummett et al, 2002;Glassman, 1993;Attebring et al, 2004;Kronish et al, 2006;Schrader et al, 2006;Thorndike et al 2008;Dawood et al 2008). Over the last few decades, research has shed light on depression in particular, and its' association with continued smoking.…”

Influence of a sedentary lifestyle on self-reported mental health status among community-dwelling older adults with depression: Implications for secondary prevention efforts

“…Mortality rates of patients being treated for acute coronary syndrome events have been shown to be influenced by whether or not the patient is persistently depressed. 19,20 This is because depressed patients can often falter in their adherence to post-event treatment regimens such as medication management and lifestyle modifications such as improved diet and exercise. 19 Similar impaired adherence has been seen for depressed patients being treated for human immunodeficiency virus, diabetes, and other chronic diseases.…”