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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Depression and Cardiovascular Health Care Costs Among Women With Suspected Myocardial Ischemia

Prospective Results From the WISE (Women's Ischemia Syndrome Evaluation) Study

Thomas Rutledge, PhD^_*,,_*, Viola Vaccarino, MD, PhD, B. Delia Johnson, PhD^||, Vera Bittner, MD, MSPH^#, Marian B. Olson, MS^||, Sarah E. Linke, BA^,, Carol E. Cornell, PhD^_**, Wafia Eteiba, MD^||, David S. Sheps, MD^,, Jennifer Francis, PhD, David S. Krantz, PhD, C. Noel Bairey Merz, MD^||||, Susmita Parashar, MD, MPH, MS, Eileen Handberg, PhD, Diane A. Vido, MS^¶ and Leslee J. Shaw, PhD^_**

^_* Veterans Affairs San Diego Healthcare System, San Diego, California
University of California, San Diego, California
San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
Emory University, Atlanta, Georgia
^|| University of Pittsburgh, Pittsburgh, Pennsylvania
^¶ Allegheny General Hospital, Pittsburgh, Pennsylvania
^# University of Alabama at Birmingham, Birmingham, Alabama
^_** University of Arkansas for Medical Sciences, Little Rock, Arkansas
University of Florida, Gainesville, Florida
North Florida/South Georgia Veterans Affairs Healthcare System, Gainesville, Florida
Uniformed Services University of the Health Sciences, Bethesda, Maryland
^|||| Cedars-Sinai Medical Center, Los Angeles, California

Manuscript received April 8, 2008; revised manuscript received September 8, 2008, accepted September 9, 2008.

^_* Reprint requests and correspondence: Dr. Thomas Rutledge, Psychology Service 116B, Veterans Affairs San Diego Healthcare System, Medical Center, 3350 La Jolla Village Drive, San Diego, California 92161 (Email: Thomas.Rutledge{at}va.gov).

Objectives: This study evaluated 3 novel questions in a prospective clinical cohort of women undergoing evaluation for suspected myocardial ischemia: 1) What is the relationship between depression and cardiovascular costs? 2) Does the relationship vary by definition of depression? 3) Do depression-cost relationship patterns differ among women with versus without coronary artery disease (CAD)?

Background: Comorbid depression has been linked to higher medical costs in previous studies of cardiovascular patients.

Methods: A total of 868 women presenting with suspected myocardial ischemia completed an extensive baseline examination including cardiovascular risk factor assessment and coronary angiogram. Depression was defined by: 1) current use of antidepressants; 2) a reported history of depression treatment; and 3) Beck Depression Inventory scores. Direct (hospitalizations, office visits, procedures, and medications) and indirect (out-of-pocket, lost productivity, and travel) costs were collected through 5 years of follow-up to estimate cardiovascular costs.

Results: Using the study criteria, 17% to 45% of the women studied met study depression criteria. Depressed women showed adjusted annual cardiovascular costs $1,550 to $3,300 higher than nondepressed groups (r = 0.08 to 0.12, p < 0.05). Depression-cost relationships also varied by CAD status, with stronger associations present among women without evidence of significant CAD.

Conclusions: Depression was associated with 15% to 53% increases in 5-year cardiovascular costs, and cost differences were present using 3 definitions of depression. The results reinforce the importance of assessing depression in clinical populations and support the hypothesis that improved management of depression in women with suspected myocardial ischemia could reduce medical costs.

Key Words: depression • health care costs • prospective • cardiovascular disease • women

Abbreviations and Acronyms   BDI = Beck Depression Inventory   CAD = coronary artery disease   CVD = cardiovascular disease

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