Abstract 1112: Medication Adherence, Depression, and 1-Year Major Adverse Cardiac Events and Mortality After Acute Coronary Syndromes
BACKGROUND: Depression is a risk factor for future cardiac events and mortality in acute coronary syndrome (ACS) patients. Poor health behavior of depressed patients may account in part for this risk. We tested whether adherence to aspirin mediates the association between depressive symptoms and one-year adverse cardiac outcomes and mortality.
METHODS: Within 1-week of hospitalization for an ACS, 168 patients completed the Beck Depression Inventory as a measure of depressive symptom severity. After discharge, aspirin adherence was electronically monitored using the Medication Event Monitoring System. Major adverse cardiac events (MACE; non-fatal myocardial infarction, hospitalization for unstable angina, urgent revascularization) and all-cause mortality were surveyed for 1 year.
RESULTS: In-hospital depressive symptom severity was associated with lower aspirin adherence during the first 7-days post-discharge (r=−.24, P=.02). Depressive symptom severity (adjusted hazard ratio [HR]=1.54; 95% confidence interval [CI], 1.04 –2.27) and 7-day adherence (adjusted HR=0.57; 95% CI, 0.37– 0.88) each individually predicted 1-year MACE/mortality. With both predictors in the model, the age- and sex-adjusted hazard ratio for depressive symptom severity was no longer significant, whereas adherence remained a significant predictor of MACE/mortality (adjusted HR=0.61; 95% CI, 0.38 – 0.99). Aspirin adherence accounted for 31% of the association between depressive symptom severity and MACE/mortality. Results remained unchanged when controlling for left ventricular function or medical comorbidities.
CONCLUSIONS: Part of the prognostic risk that is conferred by depression in post-ACS patients may be explained by poor medication adherence. Improving medication adherence alongside depressive symptoms might be a promising target for future interventions.