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CHRISTOPHER M. BLANCHETTE, PH.D., is Associate Scientist and Director, Center for Pharmacoeconomics and Outcomes Research, Lovelace Respiratory Research Institute, Kannapolis, NC, and Adjunct Assistant Professor, Division of Pharmaceutical Outcomes and Policy, School of Pharmacy, University of North Carolina, Chapel Hill. LINDA SIMONI-WASTILA, B.S.PHARM, PH.D., is Associate Professor, Peter Lamy Center on Drug Therapy and Aging; FADIA SHAYA, PH.D., M.P.H ., is Associate Professor, Department of Pharmaceutical Health Services Research, University of Maryland Baltimore School of Pharmacy, Baltimore. DENISE ORWIG, PH.D., is Associate Professor, Department of Epidemiology and Preventive Medicine, School of Medicine. JASON NOEL, PHARM.D., is Director of Clinical Services at Rosewood Center, University of Maryland Baltimore School of Pharmacy. BRUCE STUART, PH.D., is Parke-Davis Endowed Chair in Geriatric Pharmacotherapy, and Professor and Executive Director, Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, University of Maryland Baltimore School of Pharmacy.

Address correspondence to Dr. Blanchette at the Lovelace Respiratory Research Institute, 115 West Avenue, Kannapolis, NC 28081 (cblanchette{at}Lrri.org).

Purpose. The association between a diagnosis of depression after a thromboembolic event (TEE) and an increase in acute health care use was examined. Methods. A cohort of Medicare beneficiaries who were 65 years of age and older, who resided in the community, and who also experienced a TEE was constructed from the 1997–2001 Medicare Current Beneficiary Survey. Beneficiaries were assessed for TEEs and depression using the International Classification of Diseases, 9th Revision, Clinical Modification codes listed on Medicare claims. Time to first emergency department (ED) visit, inpatient hospitalization, and outpatient hospital visit were assessed using Cox-proportional hazard models. Counts of offices visits were assessed using negative binomial-regression models. Results. Of the 7051 elderly patients included in the analysis, the total number with a claim for depression within 6 months of having a TEE was 380 (5.4%), including 259 antidepressant users (68.2% of depressed elders) and 198 selective serotonin-reuptake inhibitor (SSRI) users (76.4% of antidepressant users). Over half of elders with a depression claim (52.4%) had an inpatient hospitalization within 12 months of having a TEE compared to one third of the entire study sample (36.4%). Depressed elders had a 51% greater risk of hospitalization, a 56% greater risk of ED visits, and a 19% greater risk of outpatient visits. Antidepressant use did not affect the findings and was not found to be associated with health care use. Conclusion. A claim for depression by Medicare patients was associated with the increased use of acute health care services, including hospitalizations and ED visits, in the 12 months following a TEE. Neither antidepressant use nor SSRI use was associated with an increase or reduction in risk of using such services. Index terms: Antidepressants; Depression; Geriatrics; Health care; Thromboembolism