Persistent depression affects adherence to secondary prevention behaviors after acute coronary syndromes Authors
Received: 14 September 2005 Revised: 03 November 2005 Accepted: 16 June 2006 DOI:
Cite this article as: Kronish, I.M., Rieckmann, N., Halm, E.A. et al. J Gen Intern Med (2006) 21: 1178. doi:10.1111/j.1525-1497.2006.00586.x Abstract 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. BACKGROUND: To determine whether rates of adherence to risk reducing behaviors were affected by depressive status during hospitalization and 3 months later. OBJECTIVE: Prospective observational cohort study. DESIGN: Three university hospitals. SETTING: Five hundred and sixty patients were enrolled within 7 days after ACS. Of these, 492 (88%) patients completed 3-month follow-up. PARTICIPANTS: 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 MEASUREMENTS: χ 2 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). 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. RESULTS: 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. CONCLUSIONS: Key Words cardiovascular diseases depression medication adherence prevention self care
No conflicts of interest to declare.
Presented at the National Meeting of the Society of General Internal Medicine, New Orleans, LA, May 12, 2005 and at the National Research Scholarship Awards 11th Annual Meeting, Boston, MA, June 26, 2005.
This work was financially supported by Contract HC25197, and by Grants HL076857, HL04458, and HL072866 from the National Heart, Lung, and Blood Institute, Bethesda, MD, and Grant 5D14HP00163-03-00 from the Health Resources and Services Administration, Rockville, MD.
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