Differences in trends in blood pressure and lipid assessment in patients with and without depression with atherosclerotic cardiovascular disease

Abstract

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): British Heart Foundation. Background Patients who have atherosclerotic cardiovascular disease (aCVD) and depression are at increased risk of future CVD events compared to those without depression. The reasons for this are not fully understood. Appropriate management of aCVD risk factors (RF) including blood pressure (BP) and Lipids are essential for secondary prevention. Aim To explore BP and lipid assessment over time in patients with aCVD with and without depression, in the Welsh population. Methods A retrospective observational cohort study of patients with aCVD was conducted using individual level linked electronic health record data between 2009 & 2019 using the all-Wales SAIL databank. Clinical codes were used to identify aCVD and depression diagnoses, and BP and lipid assessments from GP data. Numbers having assessment of BP and/or lipids during each calendar year were documented. Results In 2009, the cohort consisted of 183,275 (F=44.2%, mean age= 69.6 (SD=12.3)). 58.5% of patients had both BP and lipid assessments in that year, with 15.1% having BP only, 2.8% lipid only and 23.6% with neither. Over the subsequent 10y, the proportion with neither BP or lipid checks (23.6% 2009 vs 31.7% 2019, Fig 1.A) and the proportion with only one or neither RF checked increased (Fig 1.A). When comparing those with a history of depression to those without, the worsening trend over time was similar, but patients without depression were more likely to have neither RF checked (13.6% in those with depression vs 26.4% in those without in 2009 and 22.3% vs 35.7% respectively in 2019 Fig 1.B). Conclusion These data show a concerning trend for BP and lipids to be checked less rigorously for secondary prevention of aCVD. Although historically aCVD patients with a history of depression are more likely to have a worse outcome, RF assessment is more comprehensive in these patients in Wales. Whether differences in RF control may contribute to variation in outcomes between those with and without depression remains to be determined.