Depression may be associated with reduced adherence to direct-acting oral anticoagulants in atrial fibrillation patients

1. In this cross-sectional study, the odds of adequate or optimal adherence to direct-acting oral anticoagulants were lower in atrial fibrillation (AF) patients with depression than those without.

2. However, AF patients with depression demonstrated no difference in adherence to warfarin compared to those without.

Evidence Rating Level: 3 (Average)

Depression is a highly prevalent mental health disorder and is quite common in patients with atrial fibrillation (AF). Depression is associated with reduced medication adherence in many diseases, and this may be a mechanism whereby AF patients with depression experience higher rates of adverse events than those without. However, the association between depression and adherence to oral anticoagulation treatment in AF is poorly understood. This study aimed to investigate the impact of depression on medication adherence in patients with AF.

This cross-sectional study included 101,041 individuals with AF who began treatment with direct-acting oral anticoagulants (DOACs) or warfarin between 2013 and 2019. Participants were included if they had at least one inpatient or two outpatient diagnoses of AF. Participants were excluded if sex was unknown, they lived in a long-term care facility, had a diagnosis of mitral valve stenosis, or had a CHADSVASc score <2. Data were obtained from a US administrative database of commercial and Medicare insurance and outpatient pharmacy claims and identified claims. Medication adherence was calculated as the proportion of days covered (PDC), with PDC ≥80% defined as adherent and ≥90% considered optimally adherent. The primary outcome was the difference in adherence between AF patients with and without depression.

The results demonstrated that AF patients with depression were significantly less likely to achieve adequate and optimal 12-month adherence to DOACs than those without. However, there was no association between depression and adherence to warfarin. Analyses of individual DOAC agents found that depression was associated with a decreased likelihood of adequate and optimal adherence to apixaban and rivaroxaban but not dabigatran and edoxaban. However, the study was limited by the use of PDC as a measurement of adherence, which does not necessarily reflect medication use. Nonetheless, the study suggested that depression may have a negative impact on DOAC adherence in patients with AF.

Click to read the study in Journal of the American Heart Association

Image: PD

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