Abstract EP56: Trends In Behavioral And Social Determinants Of Cardiovascular Disease Amongst Depressed Coronary Heart Disease Patients
Authors: Chinelo Onyilofor, Andrea Duran, Othanya Garcia, Samantha Flores, Cara McMurry, Sung Lee, Jennifer Mizhquiri Barbecho, Nora Ospina, Vishnu Datla Raju, Kaitlin Shaw, Nathalie Moise
Journal: Circulation (2022)

Introduction: Elevated depressive symptoms in coronary heart disease (CHD) patients increases the risk of recurrent cardiovascular events and mortality. Experts posit that behavioral determinants like physical inactivity, patient activation/healthcare engagement, and depression treatment uptake may mediate this relationship. Social determinants like access to high-resourced/integrated clinical settings have also emerged, independent of patient-level demographics/factors. We sought to examine the impact of social determinants on trends in behavioral risk factors among CHD patients. Methods: As part of a trial of an electronic shared decision-making tool in depressed CHD patients (iHeart DepCare), we recruited English and Spanish-speaking patients with upcoming internal medicine and cardiology clinic appointments in 8 geographically and socioeconomically diverse clusters of clinics in NY from April 2019 to August 2021. Eligible participants were aged ≥21 years with an ICD10 code for CHD and a Patient Health Questionnaire-9 ≥10 but not under psychiatric care. Baseline questionnaires included the patient activation measure, international physical activity questionnaire, and self-reported preferred mental health treatment. We used descriptive statistics and logistic regression to examine pre-post changes in behavioral risk factors (2020-2021 vs. 2019) overall and by system-level resources (6 commercial insured/extensively resourced clinics [high] vs. 2 Medicaid only/limited resources [low]). Results: Of the 627 screened patients, 96 (15.3%) of CHD patients had elevated depressive symptoms; 22.4% in low-resourced vs. 6.2% high-resourced clinics (p&lt;0.001). The mean (standard deviation [SD]) age of depressed CHD patients was 66.5 (11.6); 64.2% were female, 72.8% Hispanic, 16.8% Black. Over the last 2 years, depression screen positive rates remained unchanged but depressed CHD patients demonstrated lower patient activation (39.1 vs. 34.9, p=0.050) and interest in therapy/cardiac rehab but greater interest in antidepressants (p&lt;0.001). Mean (SD) days exercising were overall low (1.3 [2.0]). Social/system-level factors were not associated with behavioral risk factors of recurrent cardiovascular disease. Conclusion: Over the last 2 years, patient activation, a key predictor of cardiovascular risk, worsened among depressed CHD patients. While social/system-level factors (i.e., lack of quality care) may contribute to depression burden, once depressed, CHD patients demonstrate suboptimal preventative behaviors, like physical activity, engagement/activation, and depression treatment-seeking, regardless of system-level resources. Future research should elucidate reasons for waning interest in cardiac rehab and therapy in this high-risk population, and consider activation interventions that meet patients in their communities or homes.