The effect of mental health conditions on the use of oral anticoagulation therapy in patients with atrial fibrillation: the FinACAF study

Abstract

Aims Little is known about the effects of mental health conditions (MHC) on the utilization of oral anticoagulant (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 (NOAC). Methods and Results The FinACAF registry included all 239222 patients diagnosed with incident AF during 2007-2018 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 fulfilled psychiatric medication prescription within preceding year form 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%. Lower proportion of patients with any MHC compared to those without MHCs were initiated with 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 entire follow-up. Any MHC remained associated with impaired incidence of OAC initiation also in the NOAC-era during 2015-2018 (aSHR 0.821; 95% CI 0.805-0.837). Conclusion MHCs are common among AF patients, and they are associated with lower rate of OAC initiation even during the NOAC-era.

Association of income and educational levels with adherence to direct oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study

“…The current substudy was conducted within a cohort of patients with incident AF between 2007 and 2018, established in previous studies of the FinACAF cohort. 22 , 23 …”

“…Follow‐up continued until death or 31st December 2018, whichever occurred first. The current substudy was conducted within a cohort of patients with incident AF between 2007 and 2018, established in previous studies of the FinACAF cohort 22,23 …”

“…The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) Study (ClinicalTrials Identifier: NCT04645537; ENCePP Identifier: EUPAS29845) is a retrospective nationwide cohort study covering all patients with diagnosed AF in Finland during 2004-2018. 21 Patients were identified from all available national health care registers (hospitalizations and outpatient specialist visits: HILMO; primary health care: AvoHILMO; and National Reimbursement Register 22,23 Patients not receiving DOACs during 2011-2018, when DOACs have been approved for stroke prevention in patients with AF, were excluded. Thereafter, we established two separate study cohorts for the analyses of implementation and persistence.…”

Socioeconomic disparities in use of rhythm control therapies in patients with incident atrial fibrillation: A Finnish nationwide cohort study

“…The exclusion criteria were age < 18 years at AF diagnosis and permanent migration abroad before December 31st, 2018. The present substudy was conducted within a cohort of patients with incident AF, established in previous studies of the FinACAF cohort [20] , [21] , [22] . However, patients entering the cohort before the introduction of AF specific ablation codes in 2010 were excluded.…”

An Updated Meta-Analysis of DOACs vs. VKAs in Atrial Fibrillation Patients With Bioprosthetic Heart Valve

“…Subsequently, the full-text screening led to the exclusion of 12 articles based on the predefined criteria. Finally, a total of 11 studies [two post-hoc analyses of RCTs (14, 15), 2 RCTs (16,17), and seven observational studies (18)(19)(20)(21)(22)(23)(24)] were included in our meta-analysis. The baseline characteristics of the included studies are illustrated in Table 1.…”