1 Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Denmark.
2 Department of Clinical Medicine, Aarhus University, Silkeborg Hospital, Silkeborg, Denmark.
Eur J Prev Cardiol. 2019 Jan;26(2):187-195. doi: 10.1177/2047487318811184. Epub 2018 Nov 19.
Depression is associated with an increased risk of a series of cardiovascular diseases and with increased symptom burden in patients with atrial fibrillation. The aim of this study was to determine the association between depression as well as antidepressant treatment and the risk of incident atrial fibrillation.
A nationwide register-based study comparing the atrial fibrillation risk in all Danes initiating antidepressant treatment from 2000 to 2013 ( N = 785,254) with that in a 1:5-matched sample from the general population.
Cox regression was used to estimate adjusted hazard ratios (aHRs) and associated 95% confidence intervals (95% CIs), both after initiation of treatment and in the month before when patients were assumed to have medically untreated depression.
Antidepressant treatment was associated with a three-fold higher risk of atrial fibrillation during the first month (aHR = 3.18 (95% CI: 2.98-3.39)). This association gradually attenuated over the following year (aHR = 1.37 (95% CI: 1.31-1.44) 2-6 months after antidepressant therapy initiation, and aHR = 1.11 (95% CI: 1.06-1.16) 6-12 months after). However, the associated atrial fibrillation risk was even higher in the month before starting antidepressant treatment (aHR = 7.65 (95% CI: 7.05-8.30) from 30 to 15 days before, and aHR = 4.29 (95% CI: 3.94-4.67) the last 15 days before). Overall, 0.4% of patients were diagnosed with atrial fibrillation from 30 days before to 30 days after antidepressant treatment.
Antidepressant users had a substantially increased atrial fibrillation risk, particularly before treatment initiation. Whether this mirrors a causal relation between depression and atrial fibrillation may have large consequences for public health and should be discussed.
抑郁症与一系列心血管疾病的风险增加有关，并使房颤患者的症状负担加重。本研究旨在确定抑郁症以及抗抑郁治疗与房颤发病风险之间的关系。
这是一项全国范围内基于登记的研究，比较了 2000 年至 2013 年期间开始抗抑郁治疗的所有丹麦人（n=785254 人）与一般人群中按 1：5 匹配的样本的房颤风险。
使用 Cox 回归估计调整后的危险比（aHR）及其相关的 95%置信区间（95%CI），包括治疗开始后和假设患者在没有接受药物治疗的抑郁症的前一个月。
抗抑郁治疗后第一个月房颤的风险增加了三倍（aHR=3.18（95%CI：2.98-3.39））。这种关联在接下来的一年中逐渐减弱（抗抑郁治疗开始后 2-6 个月时 aHR=1.37（95%CI：1.31-1.44），6-12 个月时 aHR=1.11（95%CI：1.06-1.16））。然而，在开始抗抑郁治疗前一个月，房颤的风险甚至更高（从治疗前 30 天至 15 天前 aHR=7.65（95%CI：7.05-8.30），治疗前最后 15 天 aHR=4.29（95%CI：3.94-4.67））。总体而言，抗抑郁治疗后 30 天至 30 天内，有 0.4%的患者被诊断为房颤。
抗抑郁药物使用者的房颤风险显著增加，尤其是在治疗开始前。这种情况是否反映了抑郁症和房颤之间的因果关系，可能对公共卫生产生重大影响，应予以讨论。
