Manja Veena, Phibbs Ciaran S, Ananth Lakshmi, Saechao Fay, Frayne Susan M
Veterans Affairs, Northern California Health Care System, Mather, California, USA.
University of California, Davis, California, USA.
CJC Open. 2025 Feb 21;7(5):555-563. doi: 10.1016/j.cjco.2025.02.014. eCollection 2025 May.
Mental health condition (MHC)-related oral anticoagulant prescribing disparities in atrial fibrillation have been reported. We evaluated oral anticoagulant prescribing for atrial fibrillation with the use of 2019 data and compared results with a previous analysis of warfarin prescribing that used 2004 data to evaluate impact of direct oral anticoagulant availability on oral anticoagulant prescribing.
This cross-sectional analysis compared oral anticoagulant prescribing in atrial fibrillation for patients with and without MHCs by means of Poisson regression and compared with a previous analysis.
Of 305,937 patients with atrial fibrillation and CHADSVASc score ≥ 2, 104,050 (34%) were diagnosed with MHCs. In unadjusted analyses, veterans with an MHC were marginally more likely to receive oral anticoagulants (relative risk [RR] 1.02. 95% confidence interval [CI] 1.02-1.03) vs veterans without an MHC. In adjusted analyses, veterans with any MHC were marginally less likely to receive oral anticoagulants vs veterans with no MHC (RR 0.95, 95% CI 0.95-0.96, when adjusted for age, sex, race, and comorbidities); more pronounced disparities were noted for veterans with specific MHCs, particularly psychosis. Modest improvements in oral anticoagulant prescribing were noted compared with 2004 data for warfarin prescribing. Persistent disparities in prescribing were noted for anxiety disorder, psychotic disorder, schizophrenia, bipolar disorder, and alcohol/drug use disorder.
Significant disparities in oral anticoagulant prescribing for persons with atrial fibrillation and MHCs persist. Further research should evaluate the drivers of disparate prescribing and implement processes to ensure equitable prescribing.
已有报道称心房颤动患者中与心理健康状况（MHC）相关的口服抗凝药处方存在差异。我们利用2019年的数据评估了心房颤动患者的口服抗凝药处方情况，并将结果与之前一项使用2004年数据评估直接口服抗凝药可用性对口服抗凝药处方影响的华法林处方分析结果进行了比较。
这项横断面分析通过泊松回归比较了有和没有MHC的心房颤动患者的口服抗凝药处方情况，并与之前的分析进行了比较。
在305,937名CHADSVASc评分≥2的心房颤动患者中，104,050名（34%）被诊断为患有MHC。在未调整的分析中，患有MHC的退伍军人接受口服抗凝药的可能性略高于没有MHC的退伍军人（相对风险[RR]为1.02，95%置信区间[CI]为1.02 - 1.03）。在调整分析中，与没有MHC的退伍军人相比，患有任何MHC的退伍军人接受口服抗凝药的可能性略低（调整年龄、性别、种族和合并症后，RR为0.95，95%CI为0.95 - 0.96）；患有特定MHC的退伍军人，尤其是精神病患者，差异更为明显。与2004年华法林处方数据相比，口服抗凝药处方有适度改善。焦虑症、精神病性障碍、精神分裂症、双相情感障碍以及酒精/药物使用障碍患者在处方方面仍存在持续差异。
心房颤动患者和患有MHC的患者在口服抗凝药处方方面仍存在显著差异。进一步的研究应评估处方差异的驱动因素，并实施相关流程以确保公平处方。
