Key result
Antidepressant prescribing was slightly higher among patients with depression and newly recorded coronary heart disease (76.4%) compared to those with previously recorded disease (71.6%) or no history of the disease (69.5%).
Why the study?
Little is known about the identification and care of patients with comorbid CHD and depression in general practice, despite the role of antidepressants and psychotherapy in reducing further CHD events.
Cohort (n=880,900)
Yes
Absolute Event Rate: 76.4% vs 71.6%
Antidepressant prescribing for depression is slightly higher in patients with newly recorded CHD compared to those without, but significant geographic disparities exist, with lower prescribing rates for men in rural areas.
Slightly higher antidepressant prescribing after new CHD diagnosis warrants clinical vigilance for depression; leaves open optimal management and geographic equity.
BACKGROUND: Incident depression is associated with coronary heart disease (CHD) and increased morbidity and mortality. Treatment of depression with antidepressants and psychotherapy can be beneficial for these patients to reduce the risk of further CHD events. Ongoing management of CHD and depression mainly occurs in the community, but little is known about the identification and care of patients with comorbid CHD and depression in general practice. This study explores the prescription of antidepressants for these patients by sociodemographic variables. METHODS: This is an open cohort study with de-identified data based on electronic medical records of 880,900 regular patients aged 40 + years from a national general practice database in Australia (MedicineInsight). Data from 2011-2018 was used to classify patients as newly recorded CHD (CHD recorded in 2018 but not in previous years), previously recorded CHD (CHD recorded between 2011-2017) or no recorded history of CHD. Antidepressant prescribing in 2018 considered active ingredients and commercial brand names. The association between sociodemographic variables and antidepressant prescribing was tabulated according to the CHD status. RESULTS: The proportion of current depression among patients with newly recorded CHD was 11.4% (95%CI 10.3-12.6), 10.5% among those with previously recorded CHD (95%CI 10.0-11.1) and 9.6% among those with no recorded history of CHD (95%CI 9.2-10.1). Antidepressant prescribing was slightly higher among those with newly recorded CHD (76.4%; 95%CI 72.1-80.6) than among those with previously recorded CHD (71.6%; 95%CI 69.9-73.2) or no history of CHD (69.5%; 95%CI 68.6-70.4). Among males with newly recorded CHD and depression, antidepressant prescribing was more frequent in major cities or inner regional areas (~ 81%) than in outer/remote Australia (66.6%; 95% CI 52.8-80.4%). CONCLUSIONS: Although antidepressant prescribing was slightly greater in those with newly recorded CHD compared to those with depression alone, its clinical significance is uncertain. Much larger differences in prescribing were seen by geographic location and could be addressed by innovations in clinical practice.
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Jahan et al. (2022) conducted a cohort in Depression and Coronary Heart Disease (n=880,900). Antidepressant prescribing vs. Previously recorded CHD or no history of CHD was evaluated on Antidepressant prescribing rate among patients with current depression. Antidepressant prescribing was slightly higher among patients with depression and newly recorded coronary heart disease (76.4%) compared to those with previously recorded disease (71.6%) or no history of the disease (69.5%).
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