Abstract 8741: Depressive Symptoms and Medication Adherence have a Synergistic Effect on Cardiac Event-Free Survival in Patients with Heart Failure

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Background: Depressive symptoms and medication nonadherence predict hospitalization and death in patients with heart failure (HF). Patients with depressive symptoms have lower medication adherence. However, the combined effects of depressive symptoms and medication nonadherence on hospitalization and death have not been investigated in patients with HF. Objective: To explore the combined effect of depressive symptoms and medication adherence on cardiac event-free survival in patients with HF. Method: This was a longitudinal study of 218 patients with HF (male 65%, age 60±12 years, NYHA class III/IV 56%). Medication adherence was assessed using a valid and objective measure, the Medication Event Monitoring System (MEMS). Depressive symptoms were measured using the Patient Health Questionnaire (PHQ). Patients were followed for up to 4 years to collect data on cardiac event-free survival (i.e., cardiac emergency department visit, hospitalization, and death). Patients were grouped using an evidence-based cutpoint of 88% on medication adherence from the MEMS data and a score 10 on the PHQ. Kaplan-Meier, log-rank tests and Cox regressions were used to compare cardiac event-free survival among groups. Results: Depressive symptoms and medication adherence were independent predictors of cardiac event-free survival ( p < .001 and = .006, respectively, Figure 1). Patients who had depressive symptoms and were nonadherent had a 4.95 times higher risk of cardiac events than those who had no depressive symptoms and were adherent (Figure 2). Conclusion: Depressive symptoms and medication nonadherence work synergistically to reduce cardiac event-free survival in patients with HF.