Relevance of depression for anticoagulation management in a routine medical care setting: results from the ThrombEVAL study program

J Thromb Haemost. 2014 Dec;12(12):2024-33. doi: 10.1111/jth.12743. Epub 2014 Oct 29.

Abstract

Background: Depressive symptoms have detrimental effects on quality of life and mortality. Poor adherence to a treatment regimen is a potential mechanism for the increased risk of adverse medical events associated with depression. Regarding oral anticoagulation with vitamin K antagonists, adherence is crucial for the outcome. Little is known about the clinical relevance of current depressiveness for anticoagulation treatment.

Objectives: To examine the impact of current depressiveness on anticoagulation treatment in regular medical care.

Patients/methods: We examined the association between clinically significant depressiveness as assessed by the Patient Health Questionnaire-2 ≥ 2 (PHQ-2 ≥ 2) with the percentage of time in the therapeutic range (TTR), self-rated compliance, several aspects of health literacy, anticoagulation side-effects and treatment satisfaction in a cross-sectional study of 1790 oral anticoagulation outpatients.

Results: Seven hundred and sixteen participants (40.0%) had clinically significant depressive symptoms. Depressed persons reported lower compliance with intake of prescribed medication and regular visits for control of anticoagulation, more unspecific side-effects (e.g. pruritus) and lower satisfaction with the anticoagulation treatment and their doctors' expertise and empathy. Depressed as compared with non-depressed individuals had a lower TTR (-4.67; 95% CI, -8.39 to -0.95). Increasing severity of depressiveness was related with decreasing TTR. However, depressiveness lost its significant impact on TTR after multivariable adjustment (-3.11; 95% CI, -6.88 to 0.66).

Conclusions: Clinically significant depressiveness was highly prevalent and impaired several aspects of anticoagulation treatment. Depressiveness should be regarded as a clinically significant condition that needs to be addressed in the management of anticoagulation patients.

Keywords: ambulatory care; anticoagulants; depression; medication adherence; patient satisfaction; phenprocoumon.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Aged
  • Ambulatory Care
  • Anticoagulants / administration & dosage
  • Anticoagulants / therapeutic use*
  • Cohort Studies
  • Cross-Sectional Studies
  • Depression / complications*
  • Female
  • Humans
  • International Normalized Ratio
  • Male
  • Medication Adherence
  • Middle Aged
  • Multivariate Analysis
  • Patient Satisfaction
  • Phenprocoumon / administration & dosage
  • Prevalence
  • Quality of Life
  • Surveys and Questionnaires
  • Treatment Outcome

Substances

  • Anticoagulants
  • Phenprocoumon