Abstract
Introduction: One in three American women die of cardiovascular (CV) disease annually, and women Veterans suffer higher risk, especially those with mental health burden. To improve CV risk identification, we implemented a CV risk screener template in 5 VA primary care clinics. Objective: To examine factors associated with CV screening in a cohort of women with depression. Methods: The cohort included all women with at least one primary care visit during the study period (12/2016-03/2020) with a depression diagnosis. We used t-tests/chi-square to compare CV screener completion vs not, and modeled completion with logistic regression including demographics, CV risk conditions, utilization, and PTSD adjusting for site-level clustering. Results: Among 6009 women, 2090 (35%) had diagnosed depression in the past two years and 582 (28% with depression) had a completed screener. For women with depression, screener completion was more likely for women who were older (48 vs. 45 years), White (46% vs. 36%), obese (49% vs. 39%), diagnosed with hyperlipidemia (39% vs. 33%), hypertension (36% vs. 27%), or diabetes (16% vs. 12%), had more primary care visits (3 vs 1) and without PTSD (46% vs. 54%; p<0.01 for each comparison). In the full logistic model, obese women had greater odds (OR 1.8, 95%CI 1.3-2.3), whereas women with PTSD had lower odds (OR 0.7, 95% CI 0.5-0.8) of screener completion. Conclusions: Women Veterans have a high prevalence of depression and other mental health conditions putting them at higher risk for CV disease. Our sample of women with depression had more traditional CV risks, yet, obesity and PTSD were the driving factors of the CV screening within primary care. Since PTSD is a significant predictor in ischemic heart disease in women Veterans, mechanisms to leverage CV screening and intervention in this population are paramount so that providers and patients do not miss opportunities for risk reduction.
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