Mental health conditions and use of rhythm control therapies in patients with atrial fibrillation: a nationwide cohort study

Konsta Teppo, Jussi Jaakkola, Fausto Biancari, Olli Halminen, Jukka Putaala, Pirjo Mustonen, Jari Haukka, Miika Linna, Janne Kinnunen, Alex Luojus, Saga Itäinen-Strömberg, Tero Penttilä, Mikko Niemi, Juha Hartikainen, Ke Juhani Airaksinen, Mika Lehto, Konsta Teppo, Jussi Jaakkola, Fausto Biancari, Olli Halminen, Jukka Putaala, Pirjo Mustonen, Jari Haukka, Miika Linna, Janne Kinnunen, Alex Luojus, Saga Itäinen-Strömberg, Tero Penttilä, Mikko Niemi, Juha Hartikainen, Ke Juhani Airaksinen, Mika Lehto

Abstract

Objectives: 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).

Design: A nationwide retrospective registry-based cohort study.

Setting: 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.

Participants: 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%.

Outcomes: Primary outcome was use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription.

Results: 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.

Conclusions: Among patients with AF, a clear disparity exists in AAT use between those with and without MHCs.

Trial registration number: ClinicalTrials Identifier: NCT04645537; ENCePP Identifier: EUPAS29845.

Keywords: cardiac epidemiology; cardiology; depression & mood disorders; mental health; schizophrenia & psychotic disorders.

Conflict of interest statement

Competing interests: KT: none. Jussi Jaakkola: none. Fausto Biancari: None Olli Halminen: none. JP: Dr Putaala reports personal fees from Boehringer-Ingelheim, personal fees and other from Bayer, grants and personal fees from BMS-Pfizer, personal fees from Portola, other from Amgen, personal fees from Herantis Pharma, personal fees from Terve Media, other from Vital Signum, personal fees from Abbott, outside the submitted work. PM: Consultant: Roche, BMS-Pfizer-alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. JH: Consultant: Research Janssen R&D; Speaker: Bayer Finland. ML: Speaker: BMSPfizer-alliance, Bayer, Boehringer-Ingelheim. JK: none. AL: none. SI: research grants from Otto A. Malm foundation and Einar & Karin Stroems Foundation. JH: Research grants: The Finnish Foundation for Cardiovascular Research, EU Horizon 2020, EU FP7. Advisory Board Member: BMS-Pfizer-alliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. JKEA: Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer-Ingelheim. Member in the advisory boards: Bayer, Pfizer and AstraZeneca. ML: Consultant: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, and MSD; Speaker: BMS-Pfizer-alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer-Ingelheim.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Cumulative ten-year incidence function of the use of any antiarrhythmic therapy with death as competing risk. MHC, mental health condition.
Figure 2
Figure 2
Proportions of patients receiving antiarrhythmic therapies (AATs) by 1-year follow-up according to the year of atrial fibrillation diagnosis. AADs, antiarrhythmic drugs; MHC, mental health condition.
Figure 3
Figure 3
Proportion of patients receiving any antiarrhythmic therapy during follow-up according to the age at atrial fibrillation diagnosis. MHC, mental health condition.

References

    1. Björck S, Palaszewski B, Friberg L, et al. . Atrial fibrillation, stroke risk, and warfarin therapy revisited: a population-based study. Stroke 2013;44:3103–8. 10.1161/STROKEAHA.113.002329
    1. Lehto M, Halminen O, Mustonen P, et al. . The nationwide Finnish anticoagulation in atrial fibrillation (FinACAF): study rationale, design, and patient characteristics. Eur J Epidemiol 2022;37:95–102. 10.1007/s10654-021-00812-x
    1. Hindricks G, Potpara T, Dagres N. ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European association for cardio-thoracic surgery (EACTS). Eur Heart J 2020;2021:42.
    1. Kirchhof P, Camm AJ, Goette A, et al. . Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med 2020;383:1305–16. 10.1056/NEJMoa2019422
    1. Alonso J, Lépine JP. Overview of key data from the European study of the epidemiology of mental disorders (ESEMeD). J Clin Psych 2007;68.
    1. Thrall G, Lip GYH, Carroll D, et al. . Depression, anxiety, and quality of life in patients with atrial fibrillation. Chest 2007;132:1259–64. 10.1378/chest.07-0036
    1. Thompson TS, Barksdale DJ, Sears SF, et al. . The effect of anxiety and depression on symptoms attributed to atrial fibrillation. Pacing Clin Electrophysiol 2014;37:439–46. 10.1111/pace.12292
    1. Teppo K, Jaakkola J, Lehto M, et al. . The impact of mental health conditions on oral anticoagulation therapy and outcomes in patients with atrial fibrillation: a systematic review and meta-analysis. Am J Prev Cardiol 2021;7:100221. 10.1016/j.ajpc.2021.100221
    1. Fleetwood K, Wild SH, Smith DJ, et al. . Severe mental illness and mortality and coronary revascularisation following a myocardial infarction: a retrospective cohort study. BMC Med 2021;19:67. 10.1186/s12916-021-01937-2
    1. Jaakkola J, Teppo K, Biancari F, et al. . The effect of mental health conditions on the use of oral anticoagulation therapy in patients with atrial fibrillation: the FinACAF study. Europ Heart J 2022;8:269–76. 10.1093/ehjqcco/qcab077
    1. Teppo K, Jaakkola J, Airaksinen KEJ, et al. . Mental health conditions and nonpersistence of direct oral anticoagulant use in patients with incident atrial fibrillation: a nationwide cohort study. J Am Heart Assoc 2022;11:e024119. 10.1161/JAHA.121.024119
    1. Teppo K, Jaakkola J, Airaksinen KEJ, et al. . Mental health conditions and adherence to direct oral anticoagulants in patients with incident atrial fibrillation: a nationwide cohort study. Gen Hosp Psychiatry 2022;74:88–93. 10.1016/j.genhosppsych.2021.12.012
    1. GBD 2019 Mental Disorders Collaborators . Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet Psychiatry 2022;9:137–50. 10.1016/S2215-0366(21)00395-3
    1. Vahia IV, Diwan S, Bankole AO, et al. . Adequacy of medical treatment among older persons with schizophrenia. Psychiatr Serv 2008;59:853–9. 10.1176/ps.2008.59.8.853
    1. van Os J, Kapur S. Schizophrenia. Lancet 2009;374:635–45. 10.1016/S0140-6736(09)60995-8
    1. Trujillo TC, Nolan PE. Antiarrhythmic agents: drug interactions of clinical significance. Drug Saf 2000;23:509–32. 10.2165/00002018-200023060-00003
    1. Timlin U, Hakko H, Heino R, et al. . A systematic narrative review of the literature: adherence to pharmacological and nonpharmacological treatments among adolescents with mental disorders. J Clin Nurs 2014;23:3321–34. 10.1111/jocn.12589
    1. Sang C-H, Chen K, Pang X-F, et al. . Depression, anxiety, and quality of life after catheter ablation in patients with paroxysmal atrial fibrillation. Clin Cardiol 2013;36:40–5. 10.1002/clc.22039
    1. Yu S, Zhao Q, Wu P, et al. . Effect of anxiety and depression on the recurrence of paroxysmal atrial fibrillation after circumferential pulmonary vein ablation. J Cardiovasc Electrophysiol 2012;23:s17–23. 10.1111/j.1540-8167.2012.02436.x
    1. Voskoboinik A, Prabhu S, Ling L-H, et al. . Alcohol and atrial fibrillation: a sobering review. J Am Coll Cardiol 2016;68:2567–76. 10.1016/j.jacc.2016.08.074
    1. Voskoboinik A, Kalman JM, De Silva A, et al. . Alcohol abstinence in drinkers with atrial fibrillation. New Engl J Med 2020;382:20–8. 10.1056/NEJMoa1817591
    1. Takigawa M, Takahashi A, Kuwahara T, et al. . Impact of alcohol consumption on the outcome of catheter ablation in patients with paroxysmal atrial fibrillation. J Am Heart Assoc 2016;5:4149. 10.1161/JAHA.116.004149
    1. Qiao Y, Shi R, Hou B, et al. . Impact of alcohol consumption on substrate remodeling and ablation outcome of paroxysmal atrial fibrillation. J Am Heart Assoc 2015;4:2349. 10.1161/JAHA.115.002349
    1. Kuppahally SS, Foster E, Shoor S, et al. . Short-term and long-term success of electrical cardioversion in atrial fibrillation in managed care system. Int Arch Med 2009;2:39. 10.1186/1755-7682-2-39
    1. Sund R. Quality of the Finnish hospital discharge register: a systematic review. Scand J Public Health 2012;40:505–15. 10.1177/1403494812456637

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