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Xu B, Forthman KL, Kuplicki R, Ahern J, Loughnan R, Naber F, Thompson WK, Nemeroff CB, Paulus MP, Fan CC. Genetic Correlates of Treatment-Resistant Depression: Insights from Polygenic Scores Across Cognitive, Temperamental, and Sleep Traits in the All of US cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.03.24309914. [PMID: 39006419 PMCID: PMC11245070 DOI: 10.1101/2024.07.03.24309914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Background Treatment-resistant depression (TRD) is a major challenge in mental health, affecting a significant number of patients and leading to considerable economic and social burdens. The etiological factors contributing to TRD are complex and not fully understood. Objective To investigate the genetic factors associated with TRD using polygenic scores (PGS) across various traits, and to explore their potential role in the etiology of TRD using large-scale genomic data from the All of Us Research Program (AoU). Methods Data from 292,663 participants in the AoU were analyzed using a case-cohort design. Treatment resistant depression (TRD), treatment responsive Major Depressive Disorder (trMDD), and all others who have no formal diagnosis of Major Depressive Disorder (non-MDD) were identified through diagnostic codes and prescription patterns. Polygenic scores (PGS) for 61 unique traits from seven domains were used and logistic regressions were conducted to assess associations between PGS and TRD. Finally, Cox proportional hazard models were used to explore the predictive value of PGS for progression rate from the diagnostic event of Major Depressive Disorder (MDD) to TRD. Results In the discovery set (104128 non-MDD, 16640 trMDD, and 4177 TRD), 44 of 61 selected PGS were found to be significantly associated with MDD, regardless of treatment responsiveness. Eleven of them were found to have stronger associations with TRD than with trMDD, encompassing PGS from domains in education, cognition, personality, sleep, and temperament. Genetic predisposition for insomnia and specific neuroticism traits were associated with increased TRD risk (OR range from 1.05 to 1.15), while higher education and intelligence scores were protective (ORs 0.88 and 0.91, respectively). These associations are consistent across two other independent sets within AoU (n = 104,388 and 63,330). Among 28,964 individuals tracked over time, 3,854 developed TRD within an average of 944 days (95% CI: 883 ~ 992 days) after MDD diagnosis. All eleven previously identified and replicated PGS were found to be modulating the conversion rate from MDD to TRD. Thus, those having higher education PGS would experiencing slower conversion rates than those who have lower education PGS with hazard ratios in 0.79 (80th versus 20th percentile, 95% CI: 0.74 ~ 0.85). Those who had higher insomnia PGS experience faster conversion rates than those who had lower insomnia PGS, with hazard ratios in 1.21 (80th versus 20th percentile, 95% CI: 1.13 ~ 1.30). Conclusions Our results indicate that genetic predisposition related to neuroticism, cognitive function, and sleep patterns play a significant role in the development of TRD. These findings underscore the importance of considering genetic and psychosocial factors in managing and treating TRD. Future research should focus on integrating genetic data with clinical outcomes to enhance our understanding of pathways leading to treatment resistance.
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Affiliation(s)
- Bohan Xu
- Population Neuroscience and Genetics Center, Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | | | - Rayus Kuplicki
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Jonathan Ahern
- Population Neuroscience and Genetics Center, Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Center for Human Development, University of California, San Diego, La Jolla, California, USA
| | - Robert Loughnan
- Population Neuroscience and Genetics Center, Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Center for Human Development, University of California, San Diego, La Jolla, California, USA
| | - Firas Naber
- Population Neuroscience and Genetics Center, Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Wesley K. Thompson
- Population Neuroscience and Genetics Center, Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Division of Biostatistics and Bioinformatics, the Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Charles B. Nemeroff
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Martin P. Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Chun Chieh Fan
- Population Neuroscience and Genetics Center, Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Department of Radiology, University of California, San Diego, La Jolla, California, USA
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Ohm J, Jernberg T, Johansson D, Warnqvist A, Leosdottir M, Hambraeus K, Svensson P. Association of clinical trial participation after myocardial infarction with socioeconomic status, clinical characteristics, and outcomes. EUROPEAN HEART JOURNAL OPEN 2021; 1:oeab020. [PMID: 35919264 PMCID: PMC9241569 DOI: 10.1093/ehjopen/oeab020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/17/2021] [Accepted: 08/10/2021] [Indexed: 02/01/2023]
Abstract
Abstract
Aims
To investigate whether participants in clinical trials after myocardial infarction (MI) are representable for the post-MI population concerning characteristics, secondary prevention, and prognosis.
Methods and results
Cohort study on 31 792 attendants to 1-year revisits after MI throughout Sweden (n = 2941 clinical trial participants) between 2008 and 2013 identified in the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). Individual-level data on socioeconomic status (SES) (disposable income, educational level, and marital status) and outcomes (first recurrent non-fatal MI, coronary heart disease death, fatal or non-fatal stroke until study end 2018) were linked from other national registries. Trial participants were more likely to be men [risk ratio 1.09; 95% confidence interval (CI) 1.07–1.11], and married (1.07; 1.04–1.10), have a highest-quintile income (1.42; 1.36–1.48), and post-secondary education (1.25; 1.18–1.33), while less likely to have a history of MI (0.88; 0.80–0.97), be persistent smokers (0.83; 0.75–0.92) and have left ventricular dysfunction (0.59; 0.44–0.79) compared to non-participants. During a mean 6.7-year follow-up, 5206 outcome events occurred. Risk was lower in trial participants (hazard ratio 0.80; 95% CI 0.72–0.89), also after adjusting for clinical characteristics and post-MI therapies (0.85; 0.77–0.94) and additionally for SES (0.88; 0.79–0.97).
Conclusions
Clinical trial participants post-MI are more often male, have higher SES, a more advantageous risk profile, and better prognosis. Additional unmeasured participation bias was implied. Questionable external validity of post-MI trials highlights the importance of complementary studies using real-world data.
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Affiliation(s)
- Joel Ohm
- Department of Emergency Medicine, Solna, Karolinska University Hospital , Anna Steckséns gata 33 , Stockholm SE-171 76, Sweden
- Department of Medicine, Solna, Karolinska Institutet , Stockholm SE-17177, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet , Stockholm SE-18288, Sweden
| | - David Johansson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet , Stockholm SE-11883, Sweden
| | - Anna Warnqvist
- Division of Biostatistics, Institute of Environmental Medicine, Nobels väg 13, Karolinska Institutet , Stockholm SE-17177, Sweden
| | - Margrét Leosdottir
- Department of Cardiology, Skåne University Hospital , Jan Waldenströms gata 15, Malmö SE-20502, Sweden
- Department of Clinical Sciences Malmö, Lund University , Box 50332, Malmö SE-20213, Sweden
| | - Kristina Hambraeus
- Department of Cardiology, Falu Hospital , Lasarettsvägen, Falun SE-79182, Sweden
| | - Per Svensson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet , Stockholm SE-11883, Sweden
- Department of Cardiology, Södersjukhuset , Sjukhusbacken 10, Stockholm SE-11883, Sweden
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Abstract
Cardiovascular disease is the leading cause of death globally. While pharmacological advancements have improved the morbidity and mortality associated with cardiovascular disease, non-adherence to prescribed treatment remains a significant barrier to improved patient outcomes. A variety of strategies to improve medication adherence have been tested in clinical trials, and include the following categories: improving patient education, implementing medication reminders, testing cognitive behavioral interventions, reducing medication costs, utilizing healthcare team members, and streamlining medication dosing regimens. In this review, we describe specific trials within each of these categories and highlight the impact of each on medication adherence. We also examine ongoing trials and future lines of inquiry for improving medication adherence in patients with cardiovascular diseases.
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Affiliation(s)
- Steven T Simon
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Vinay Kini
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew E Levy
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Cardiology, Denver Health Medical Center, Denver, CO, USA
| | - P Michael Ho
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Cardiology Section, VA Eastern Colorado Health Care System, Aurora, CO, USA
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Batty GD, Deary IJ, Fawns-Ritchie C, Gale CR, Altschul D. Pre-pandemic cognitive function and COVID-19 vaccine hesitancy: cohort study. Brain Behav Immun 2021; 96:100-105. [PMID: 34022372 PMCID: PMC8133799 DOI: 10.1016/j.bbi.2021.05.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Whereas several predictors of COVID-19 vaccine hesitancy have been reported, the role of cognitive function is largely unknown. Accordingly, our objective was to evaluate the association between scores from an array of cognitive function tests and self-reported vaccine hesitancy after the announcement of the successful testing of the first COVID-19 vaccine (Oxford University/AstraZeneca). METHODS We used individual-level data from a pandemic-focused study ('COVID Survey'), a prospective cohort study nested within United Kingdom Understanding Society ('Main Survey'). In the week immediately following the announcement of successful testing of the first efficacious inoculation (November/December 2020), data on vaccine intentionality were collected in 11,740 individuals (6702 women) aged 16-95 years. Pre-pandemic scores on general cognitive function, ascertained from a battery of six tests, were captured in 2011/12 wave of the Main Survey. Study members self-reported their intention to take up a vaccination in the COVID-19 Survey. RESULTS Of the study sample, 17.2% (N = 1842) indicated they were hesitant about having the vaccine. After adjustment for age, sex, and ethnicity, study members with a lower baseline cognition score were markedly more likely to be vaccine hesitant (odds ratio per standard deviation lower score in cognition; 95% confidence interval: 1.76; 1.62, 1.90). Adjustment for mental and physical health plus household shielding status had no impact on these results, whereas controlling for educational attainment led to partial attenuation but the probability of hesitancy was still elevated (1.52; 1.37, 1.67). There was a linear association for vaccine hesitancy across the full range of cognition scores (p for trend: p < 0.0001). CONCLUSIONS Erroneous social media reports might have complicated personal decision-making, leading to people with lower cognitive ability being vaccine-hesitant. With individuals with lower cognition also experiencing higher rates of COVID-19 in studies conducted prior to vaccine distribution, these new findings are suggestive of a potential additional disease burden.
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Affiliation(s)
- G David Batty
- Department of Epidemiology and Public Health, University College London, UK.
| | - Ian J Deary
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, UK
| | | | - Catharine R Gale
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, UK; Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, UK
| | - Drew Altschul
- Department of Psychology, University of Edinburgh, UK
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Deary IJ, Hill WD, Gale CR. Intelligence, health and death. Nat Hum Behav 2021; 5:416-430. [PMID: 33795857 DOI: 10.1038/s41562-021-01078-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/15/2021] [Indexed: 02/06/2023]
Abstract
The field of cognitive epidemiology studies the prospective associations between cognitive abilities and health outcomes. We review research in this field over the past decade and describe how our understanding of the association between intelligence and all-cause mortality has consolidated with the appearance of new, population-scale data. To try to understand the association better, we discuss how intelligence relates to specific causes of death, diseases/diagnoses and biomarkers of health through the adult life course. We examine the extent to which mortality and health associations with intelligence might be attributable to people's differences in education, other indicators of socioeconomic status, health literacy and adult environments and behaviours. Finally, we discuss whether genetic data provide new tools to understand parts of the intelligence-health associations. Social epidemiologists, differential psychologists and behavioural and statistical geneticists, among others, contribute to cognitive epidemiology; advances will occur by building on a common cross-disciplinary knowledge base.
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Affiliation(s)
- Ian J Deary
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK.
| | - W David Hill
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Catharine R Gale
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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6
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Batty GD, Deary IJ, Fawns-Ritchie C, Gale CR, Altschul D. Pre-pandemic Cognitive Function and COVID-19 Vaccine Hesitancy: Cohort Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.16.21253634. [PMID: 33791726 PMCID: PMC8010758 DOI: 10.1101/2021.03.16.21253634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Background Whereas several predictors of COVID-19 vaccine hesitancy have been examined, the role of cognitive function following the widely publicised development of an inoculation is unknown. Objective To test the association between scores from an array of cognitive function tests and self-reported vaccine hesitancy after the announcement of the successful testing of the Oxford University/AstraZeneca vaccine. Design Setting and Participants We used individual-level data from a pandemic-focused study (COVID Survey), a prospective cohort study nested within Understanding Society (Main Survey). In the week immediately following the announcement of successful testing of the first efficacious inoculation (November/December 2020), data on vaccine intentionality were collected in 11740 individuals (6702 women) aged 16-95. Pre-pandemic scores on general cognitive function, ascertained from a battery of six tests, were captured in 2011/12 wave of the Main Survey. Measurements Self-reported intention to take up a vaccination for COVID-19. To summarise our results, we computed odds ratios with accompanying 95% confidence intervals for general cognitive function adjusted for selected covariates. Results Of the study sample, 17.2% (N=1842) indicated they were hesitant about having the vaccine. After adjustment for age, sex, and ethnicity, study members with a lower baseline cognition score were markedly more likely to be vaccine hesitant (odds ratio per standard deviation lower score in cognition; 95% confidence interval: 1.76; 1.62, 1.90). Adjustment for mental and physical health plus household shielding status had no impact on these results, whereas controlling for educational attainment led to partial attenuation but the probability of hesitancy was still elevated (1.52; 1.37, 1.67). There was a linear association for vaccine hesitancy across the full range of cognition scores (p for trend: p<0.0001). Limitations Our outcome was based on intention rather than behaviour. Conclusions Erroneous social media reports might have complicated personal decision-making, leading to people with lower cognitive ability test scores being vaccine-hesitant. With people with lower cognition also experiencing higher rates of COVID-19 in studies conducted prior to vaccine distribution, these new findings are suggestive of a potential additional disease burden.
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Affiliation(s)
- G David Batty
- Department of Epidemiology and Public Health, University College London, UK
| | - Ian J Deary
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, UK
| | | | - Catharine R Gale
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, UK
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, UK
| | - Drew Altschul
- Department of Psychology, University of Edinburgh, UK
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7
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Salvador GLDO. Back to school: How reattending a discipline can increase survival. Eur J Prev Cardiol 2020; 27:143-144. [PMID: 31412716 DOI: 10.1177/2047487319871121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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8
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Wallert J, Mitchell A, Held C, Hagström E, Leosdottir M, Olsson EM. Cardiac rehabilitation goal attainment after myocardial infarction with versus without diabetes: A nationwide registry study. Int J Cardiol 2019; 292:19-24. [DOI: 10.1016/j.ijcard.2019.04.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 03/12/2019] [Accepted: 04/16/2019] [Indexed: 10/27/2022]
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9
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Brouwers S. Drug adherence after myocardial infarction: The role of patients and physicians. Eur J Prev Cardiol 2018; 25:389-391. [DOI: 10.1177/2047487317751736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sofie Brouwers
- Department of Cardiology, University Hospital Zürich, Switzerland
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10
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Lindgren M, Eriksson P, Rosengren A, Robertson J, Schiöler L, Schaufelberger M, Åberg D, Torén K, Waern M, Åberg M. Cognitive performance in late adolescence and long-term risk of early heart failure in Swedish men. Eur J Heart Fail 2018; 20:989-997. [PMID: 29457328 PMCID: PMC6607476 DOI: 10.1002/ejhf.1163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/09/2018] [Accepted: 01/22/2018] [Indexed: 12/18/2022] Open
Abstract
Aims Heart failure (HF) incidence appears to increase among younger individuals, raising questions of how risk factors affect the younger population. We investigated the association of cognitive performance in late adolescence with long‐term risk of early HF. Methods and results We followed a cohort of Swedish men enrolled in mandatory military conscription in 1968–2005 (n = 1 225 300; mean age 18.3 years) until 2014 for HF hospitalization, using data from the Swedish National Inpatient Registry. Cognitive performance (IQ) was measured through a combination of tests, separately evaluating logical, verbal, visuospatial, and technical abilities. The results were standardized, weighted, and presented as stanines of IQ. The association between IQ and risk of HF was estimated using Cox proportional hazards models. In follow‐up, there were 7633 cases of a first HF hospitalization (mean age at diagnosis 50.1 years). We found an inverse relationship between global IQ and risk of HF hospitalization. Using the highest IQ stanine as reference, the adjusted hazard ratio for the lowest IQ with risk of HF was 3.11 (95% confidence interval 2.60–3.71), corresponding to a hazard ratio of 1.32 (95% CI 1.28–1.35) per standard deviation decrease of IQ. This association proved persistent across predefined categories of HF with respect to pre‐existing or concomitant co‐morbidities; it was less apparent among obese conscripts (P for interaction =0.0004). Conclusion In this study of young men, IQ was strongly associated with increased risk of early HF. The medical profession needs to be aware of this finding so as to not defer diagnosis.
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Affiliation(s)
- Martin Lindgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Eriksson
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Josefina Robertson
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linus Schiöler
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - David Åberg
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margda Waern
- Section of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Åberg
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Levy AE, Huang C, Huang A, Michael Ho P. Recent Approaches to Improve Medication Adherence in Patients with Coronary Heart Disease: Progress Towards a Learning Healthcare System. Curr Atheroscler Rep 2018; 20:5. [PMID: 29368179 DOI: 10.1007/s11883-018-0707-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Non-adherence to medications for the secondary prevention of myocardial infarction (MI) is a major contributor to morbidity and mortality in these patients. This review describes recent advances in promoting adherence to therapies for coronary artery disease (CAD). RECENT FINDINGS Two large randomized controlled trials to "incentivize" adherence were somewhat disappointing; neither financial incentives nor "peer pressure" successfully increased rates of adherence in the post-MI population. Patient education and provider engagement appear to be critical aspects of improving adherence to CAD therapies, where the provider is a physician, pharmacist, or nurse and follow-up is performed in person or by telephone. Fixed-dose combinations of CAD medications, formulated as a so-called "polypill," have shown some early efficacy in increasing adherence. Technological advances that automate monitoring and/or encouragement of adherence are promising but seem universally dependent on patient engagement. For example, medication reminders via text message perform better if patients are required to respond. Multifaceted interventions, in which these and other interventions are combined together, appear to be most effective. There are several available types of proven interventions through which providers, and the health system at large, can advance patient adherence to CAD therapies. No single intervention to promote adherence will be successful in all patients. Further study of multifaceted interventions and the interactions between different interventions will be important to advancing the field. The goal is a learning healthcare system in which a network of interventions responds and adapts to patients' needs over time.
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Affiliation(s)
| | - Carrie Huang
- University of Southern California, Los Angeles, California, USA
| | - Allen Huang
- University of Southern California, Los Angeles, California, USA
| | - P Michael Ho
- Department of Medicine, Denver VA Medical Center, Denver, CO, 80220, USA
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12
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Lissåker CT, Wallert J, Held C, Olsson E. Emotional distress as a predictor of statin non-adherence among Swedish first-time myocardial infarction patients, 2006-2013. J Psychosom Res 2017; 97:30-37. [PMID: 28606496 DOI: 10.1016/j.jpsychores.2017.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Emotional distress (depression and anxiety) has been known to affect mortality after a myocardial infarction (MI). One possible mechanism is through medication non-adherence. Few studies have investigated the link between statin adherence and emotional distress, and results are not consistent. We aimed to explore whether emotional distress affects adherence among first-time MI patients younger than 75years old receiving a prescription for the first time. METHODS We identified first-MI individuals younger than 75years from the SWEDEHEART national quality registers discharged with a statin prescription. The main exposure was the anxiety/depression portion of the EQ-5D from Interview 1 (6-10weeks post-MI) and Interview 2 (12-14months post-MI). We calculated adherence from the Swedish Prescribed Drugs Register during three observation periods (OP): [1] Interview 1 to Interview 2, [2] one year post Interview 2, and [3] two years post Interview 1. RESULTS Emotional distress at Interview 1 was not associated with statin adherence for OP1 (RR: 0.99, 95% CI: 0.98, 1.01). Emotional distress at Interview 2 was associated with lower adherence one year later (RR: 0.95, 95% CI: 0.93, 0.98). Emotional distress at Interview 1 was associated with a small decrease in adherence in the complete OP for adherence (RR: 0.98, 95% CI: 0.96, 0.99). CONCLUSION Emotional distress was marginally, but independently, associated with lower adherence to statin two years after the MI. Our study suggests that emotional distress may be an important factor for long-term statin adherence, and, thus, may play a clinically important role in long-term outcome.
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Affiliation(s)
- C T Lissåker
- Department of Women's and Children's Health, Uppsala University, Sweden.
| | - J Wallert
- Department of Women's and Children's Health, Uppsala University, Sweden.
| | - C Held
- Uppsala Clinical Research Center, Uppsala University, Sweden; Department of Medical Sciences: Cardiology, Uppsala University, Sweden.
| | - E Olsson
- Department of Women's and Children's Health, Uppsala University, Sweden.
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