精神健康状况与首发心房颤动患者出血事件：芬兰全国队列研究。
Mental health conditions and bleeding events in patients with incident atrial fibrillation: A Finnish nationwide cohort study.
机构信息
University of Turku, Turku, Finland.
University of Turku, Turku, Finland; Heart Unit, Satakunta Central Hospital, Pori, Finland.
出版信息
Gen Hosp Psychiatry. 2022 Sep-Oct;78:117-122. doi: 10.1016/j.genhosppsych.2022.08.003. Epub 2022 Aug 30.
OBJECTIVE
We assessed the hypothesis that mental health conditions (MHCs) are associated with higher risk of bleeding in patients with atrial fibrillation (AF).
METHODS
The registry-based FinACAF study covers all patients with AF diagnosed during 2007-2018 in Finland. MHCs of interest were depression, bipolar disorder, anxiety disorder, schizophrenia, and any MHC. The outcomes were first-ever gastrointestinal, intracranial, and any bleeding event.
RESULTS
We identified 205,019 patients (50.9% female; mean age 72.3 [standard deviation 13.4] years) with incident AF without prior bleeding, and the prevalence of any MHC was 6.1%. Any MHC, depression, and anxiety disorder were associated with the risk of any bleeding (adjusted hazard ratios (HRs) 1.19 [1.12-1.27], 1.21 [1.13-1.30], and 1.21 [1.08-1.35], respectively). Additionally, any MHC and depression were associated with the risk of gastrointestinal and intracranial bleeding and anxiety disorder with gastrointestinal bleeding. Bipolar disorder and schizophrenia were not associated with risk of bleeding. Use of oral anticoagulants was associated with the risk of any bleeding (adjusted HR 1.24 [95% CI 1.21-1.28)]), and this association was similar in patients with and without MHCs. Serotonin reuptake inhibitors were not associated with bleeding risk.
CONCLUSIONS
MHCs are associated with a higher risk of bleeding in patients with AF.
目的
我们评估了这样一种假设，即心理健康状况（MHC）与房颤（AF）患者出血风险增加有关。
方法
基于登记的 FinACAF 研究涵盖了芬兰 2007 年至 2018 年期间诊断为 AF 的所有患者。我们感兴趣的 MHC 包括抑郁、双相情感障碍、焦虑障碍、精神分裂症和任何 MHC。研究结果是首次发生的胃肠道、颅内和任何出血事件。
结果
我们确定了 205019 例无既往出血的首发 AF 患者（50.9%为女性；平均年龄 72.3[13.4]岁），任何 MHC 的患病率为 6.1%。任何 MHC、抑郁和焦虑障碍均与出血风险相关（校正后的危险比（HR）分别为 1.19[1.12-1.27]、1.21[1.13-1.30]和 1.21[1.08-1.35]）。此外，任何 MHC 和抑郁与胃肠道和颅内出血风险相关，而焦虑障碍与胃肠道出血风险相关。双相情感障碍和精神分裂症与出血风险无关。使用口服抗凝剂与出血风险相关（校正 HR 为 1.24[95%CI 1.21-1.28)]），且在有无 MHC 的患者中这种相关性相似。5-羟色胺再摄取抑制剂与出血风险无关。
结论
MHC 与 AF 患者出血风险增加相关。
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