Heart Center, Turku University Hospital, and University of Turku, Hämeentie 11, Turku, Finland.
Heart Unit, Satakunta Central Hospital, Sairaalantie 3, FI-28500 Pori, Finland.
Eur Heart J Qual Care Clin Outcomes. 2022 May 5;8(3):269-276. doi: 10.1093/ehjqcco/qcab077.
Little is known about the effects of mental health conditions (MHCs) on the utilization of oral anticoagulation (OAC) therapy in atrial fibrillation (AF) patients. We aimed to assess whether MHCs affect initiation of OAC therapy among AF patients with special focus on non-vitamin K antagonist oral anticoagulants (NOACs).
The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) registry included all 239 222 patients diagnosed with incident AF during 2007-18 in Finland identified from national registries covering primary to tertiary care and drug purchases. Patients with previous depression, bipolar disorder, anxiety disorder, or schizophrenia diagnosis or a fulfilled psychiatric medication prescription within the year preceding the AF diagnosis were classified to have any MHC. The main outcome was OAC initiation, defined as first fulfilled OAC prescription after AF diagnosis. The patients' mean age was 72.7 years and 49.8% were female. The prevalence of any MHC was 19.9%. A lower proportion of patients with any MHC compared with those without MHCs were initiated on OAC therapy (64.9% vs. 73.3%, P < 0.001). Any MHC was associated with lower incidence of OAC initiation [adjusted subdistribution hazard ratio (aSHR) 0.867; 95% confidence interval (CI) 0.856-0.880], as were depression (aSHR 0.868; 95% CI 0.856-0.880), bipolar disorder (aSHR 0.838; 95% CI 0.824-0.852), anxiety disorder (aSHR 0.840; 95% CI 0.827-0.854), and schizophrenia (aSHR 0.838; 95% CI 0.824-0.851), during the entire follow-up. Any MHC remained associated with impaired incidence of OAC initiation also in the NOAC era during 2015-18 (aSHR 0.821; 95% CI 0.805-0.837).
MHCs are common among AF patients, and they are associated with a lower rate of OAC initiation even during the NOAC era.
心理健康状况（MHC）对房颤（AF）患者口服抗凝治疗（OAC）的使用影响知之甚少。我们旨在评估 MHC 是否会影响 AF 患者开始 OAC 治疗，特别关注非维生素 K 拮抗剂口服抗凝剂（NOAC）。
芬兰抗凝治疗房颤（FinACAF）登记处纳入了 2007 年至 2018 年期间在芬兰从初级到三级护理和药物购买的全国登记处确诊为新发房颤的 239222 例患者。在房颤诊断前一年有抑郁症、双相情感障碍、焦虑症或精神分裂症诊断或有精神药物处方的患者被归类为有任何 MHC。主要结局是 OAC 开始，定义为房颤诊断后首次满足 OAC 处方。患者的平均年龄为 72.7 岁，49.8%为女性。任何 MHC 的患病率为 19.9%。与没有 MHC 的患者相比，有任何 MHC 的患者接受 OAC 治疗的比例较低（64.9% vs. 73.3%，P<0.001）。任何 MHC 与 OAC 起始率降低相关[校正亚分布风险比（aSHR）0.867；95%置信区间（CI）0.856-0.880]，抑郁症（aSHR 0.868；95%CI 0.856-0.880）、双相情感障碍（aSHR 0.838；95%CI 0.824-0.852）、焦虑症（aSHR 0.840；95%CI 0.827-0.854）和精神分裂症（aSHR 0.838；95%CI 0.824-0.851）也是如此。在整个随访期间。即使在 2015 年至 2018 年的 NOAC 时代，任何 MHC 仍然与 OAC 起始率降低相关（aSHR 0.821；95%CI 0.805-0.837）。
MHC 在 AF 患者中很常见，即使在 NOAC 时代，它们也与 OAC 起始率降低相关。
