University of Turku, Turku, Finland
University of Turku, Turku, Finland.
BMJ Open. 2022 Aug 30;12(8):e059759. doi: 10.1136/bmjopen-2021-059759.
Mental health conditions (MHCs) have been associated with undertreatment of unrelated medical conditions, but whether patients with MHCs face disparities in receiving rhythm control therapies for atrial fibrillation (AF) is currently unknown. We assessed the hypothesis that MHCs are associated with a lower use of antiarrhythmic therapies (AATs).
A nationwide retrospective registry-based cohort study.
The Finnish AntiCoagulation in Atrial Fibrillation cohort included records on all patients with AF in Finland during 2007-2018 identified from nationwide registries covering all levels of care as well as drug purchases. MHCs of interest were diagnosed depression, bipolar disorder, anxiety disorder, schizophrenia and any MHC.
We identified 239 222 patients (mean age 72.6±13.2 years; 49.8% women) with incident AF, in whom the prevalence of any MHC was 19.9%.
Primary outcome was use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription.
Lower overall use of any AAT emerged in patients with any MHC than in those without MHC (16.9% vs 22.9%, p<0.001). Any MHC, depression, bipolar disorder, anxiety disorder and schizophrenia were all associated with lower incidence of any AAT with adjusted subdistribution HRs of 0.790 (95% CI 0.771 to 0.809), 0.817 (0.796 to 0.838), 0.811 (0.789 to 0.835), 0.807 (0.785 to 0.830) and 0.795 (0.773 to 0.818), respectively. Adjusted rates of AAD, cardioversion and catheter ablation use were lower in all MHC groups compared with patients without MHC. The findings in patients with any MHC were confirmed in propensity score matching analysis.
Among patients with AF, a clear disparity exists in AAT use between those with and without MHCs.
ClinicalTrials Identifier: NCT04645537; ENCePP Identifier: EUPAS29845.
心理健康状况（MHCs）与治疗无关的医学疾病不足有关，但患有 MHCs 的患者在接受心房颤动（AF）节律控制治疗方面是否存在差异尚不清楚。我们评估了以下假设，即 MHCs 与抗心律失常治疗（AATs）的使用率较低有关。
一项基于全国回顾性登记的队列研究。
芬兰抗凝血剂治疗心房颤动队列纳入了 2007-2018 年期间芬兰所有 AF 患者的记录，这些记录来自覆盖所有护理水平和药物购买的全国登记处。感兴趣的 MHC 包括诊断为抑郁症、双相情感障碍、焦虑症、精神分裂症和任何 MHC。
我们确定了 239222 例（平均年龄 72.6±13.2 岁；49.8%为女性）新发 AF 患者，其中任何 MHC 的患病率为 19.9%。
主要结局是使用任何 AAT，包括电复律、导管消融和满足抗心律失常药物（AAD）处方。
与无 MHC 患者相比，患有任何 MHC 的患者总体上使用任何 AAT 的比例较低（16.9%比 22.9%，p<0.001）。任何 MHC、抑郁症、双相情感障碍、焦虑症和精神分裂症均与任何 AAT 的发生率较低相关，调整后的亚分布 HR 分别为 0.790（95%CI 0.771 至 0.809）、0.817（0.796 至 0.838）、0.811（0.789 至 0.835）、0.807（0.785 至 0.830）和 0.795（0.773 至 0.818）。与无 MHC 患者相比，所有 MHC 组的 AAD、电复律和导管消融的使用率均较低。在任何 MHC 患者中，这些发现都在倾向评分匹配分析中得到了证实。
在 AF 患者中，患有和不患有 MHC 的患者在 AAT 使用方面存在明显差异。
ClinicalTrials Identifier：NCT04645537；ENCePP Identifier：EUPAS29845。
