Abstract 15159: Association of Depression and Adherence to Oral Anticoagulants in Patients With Atrial Fibrillation

Abstract

Introduction: Depression may decrease adherence to cardiovascular medications. Depression has not been well studied in atrial fibrillation (AF). We examined the association of depression with adherence to direct-acting oral anticoagulants (DOACs) in AF, given their crucial role in stroke prevention. We hypothesized that individuals with depression would have decreased adherence to DOACs compared to those without. Methods: We used Optum’s de-identified Clinformatics® Data Mart Database to identify individuals with AF initiating anticoagulation with DOACs between 2013-2019. We identified depression, AF, and covariates using the claims data. We quantified adherence using proportions of days covered, categorized as limited (<80%), adequate (80 to <90%), or optimal (≥90%). We determined the multivariable-adjusted odds of 12-month adherence to DOACs in individuals with depression compared to those without. Covariates included demographics, medical and psychiatric comorbidities, household income, educational attainment, and insurance type. Results: We identified 68,800 individuals with AF who initiated DOACs (age 74.5±8.9, 50.6% female, 29.5% non-White). In those with depression (n=11,059) the odds of adequate adherence was 0.89 (95% CI, 0.85, 0.93) and optimal adherence was 0.87 (95% CI, 0.83, 0.91) compared to individuals without depression ( Figure ). Conclusions: We demonstrated that individuals with depression and comorbid AF were less likely to achieve either adequate or optimal 12-month adherence to DOACs compared to those without depression. Recognizing depression in patients with AF may guide measures to address adherence to oral anticoagulation.