Prevalence and management of vascular disease in Australian patients undergoing non-cardiac surgery

Abstract

and medication non-adherence in patients with AF was examined. Methods: Studies published between 2005 and 2015 on medication non-adherence and depression in patients with AF were examined. The key terms for screening were atrial fibrillation, medication adherence, stroke risk and depression. They were used in Medline, PubMed and Google Scholar. Results: Only 7 epidemiological studies of about 1500 patients assessed depression in patients with atrial fibrillation with 50% having depression. 5 studies assessed medication adherence in AF patients (depression was not measured in these studies). Persistence at 18 months was noted in fewer than 25% of patients. Unfortunately, depression was not assessed in these persistence trials. The recent trials of the new anticoagulant drugs (NOACs) vs. Warfarin included almost 100,000 patients. High discontinuation rates were noted of about 10% / year. Depression was not measured in these trials either. Depression is known to be a major risk factor in patients with CHD and heart failure and depressed patients are three times more likely to be non-adherent. Conclusion: Depression is a major factor for poor adherence and highly prevalent in AF patients. Treatment of depression improves adherence per se and is likely to decrease complications of AF. Screening for depression ought to be included in guidelines for management of AF.