title: Antidepressant adherence and risk of coronary artery disease hospitalizations in older and younger adults with depression.
abstract: OBJECTIVE
  To assess whether the relationship between antidepressant adherence and coronary artery disease (CAD) hospitalizations varied between older and younger adults with depression.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Department of Veterans Affairs outpatient clinics nationwide.
  
  
  METHODS
  Chronically depressed individuals (n = 50,261; aged 20-97) who had been prescribed an antidepressant were identified from records indicating an outpatient clinic visit for depression (index depression visit) during fiscal years 2009 and 2010. Individuals were considered chronically depressed if they had had prior depression visits and treatment for depression within the previous 4 months. The sample was age-stratified into younger (<65) and older (≥ 65) groups.
  
  
  METHODS
  After the index depression visit, medication possession ratios were calculated from pharmacy refill data to determine whether participants had 80% or greater adherence to antidepressant refills during a 6-month treatment observation period. International Classification of Diseases, Ninth Revision, codes were used to derive CAD-related hospitalizations during the follow-up period. Mean follow-up was 24 months. Data were analyzed using Cox proportional hazard models.
  
  
  RESULTS
  Older participants with 80% or greater antidepressant adherence had 26% lower risk of CAD hospitalizations (hazard ratio = 0.74, 95% confidence interval = 0.60-0.93). Antidepressant adherence was not significantly related to CAD hospitalizations in younger adults.
  
  
  CONCLUSIONS
  Older adults with chronic depression with 80% or greater antidepressant adherence had significantly lower risk of CAD hospitalizations at follow-up than those with less than 80% adherence. These preliminary results suggest that older adults with depression may derive cardiovascular benefits from clinical efforts to increase antidepressant adherence.
authors.affiliation: Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, Veteran Affairs Puget Sound Health Care System, Seattle, Washington; Department of Health Services, University of Washington, Seattle, Washington.
authors.forename: Denise C
authors.initials: DC
authors.lastname: Cooper
authors.forename: Ranak B
authors.initials: RB
authors.lastname: Trivedi
authors.forename: Karin M
authors.initials: KM
authors.lastname: Nelson
authors.forename: Gayle E
authors.initials: GE
authors.lastname: Reiber
authors.forename: Evercita C
authors.initials: EC
authors.lastname: Eugenio
authors.forename: Kristine A
authors.initials: KA
authors.lastname: Beaver
authors.forename: Vincent S
authors.initials: VS
authors.lastname: Fan
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications* / Q000628:therapy*; D003327:Coronary Disease; D003863:Depression / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D016903:Drug Monitoring
chemical_list: D000928:Antidepressive Agents
keywords: adherence; antidepressants; coronary artery disease; depression; hospitalizations