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

• Published in: BMJ open Vol. 12; no. 8; p. e059759
• Main Authors: Teppo, Konsta, Jaakkola, Jussi, Biancari, Fausto, Halminen, Olli, Putaala, Jukka, Mustonen, Pirjo, Haukka, Jari, Linna, Miika, Kinnunen, Janne, Luojus, Alex, Itäinen-Strömberg, Saga, Penttilä, Tero, Niemi, Mikko, Hartikainen, Juha, Airaksinen, KE Juhani, Lehto, Mika
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 30-08-2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Ablation; Age; Aged; Aged, 80 and over; Alcohol; Anti-Arrhythmia Agents - therapeutic use; Anxiety disorders; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Bipolar disorder; Cardiac arrhythmia; cardiac epidemiology; cardiology; Cardiovascular Medicine; Cardioversion; Catheter Ablation - adverse effects; Catheters; Codes; Cohort analysis; Cohort Studies; Dementia; depression & mood disorders; Diabetes; Disease; Female; Heart failure; Humans; Male; Mental depression; Mental disorders; Mental Health; Middle Aged; Mortality; Patients; Quality of life; Retrospective Studies; Schizophrenia; schizophrenia & psychotic disorders; Treatment Outcome; Variables; Womens health; Finland; schizophrenia & psychotic disorders; cardiac epidemiology; depression & mood disorders; mental health; cardiology
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-059759

ObjectivesMental 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).DesignA nationwide retrospective registry-based cohort study.SettingThe 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.ParticipantsWe 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%.OutcomesPrimary outcome was use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription.ResultsLower 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.ConclusionsAmong patients with AF, a clear disparity exists in AAT use between those with and without MHCs.Trial registration numberClinicalTrials Identifier: NCT04645537; ENCePP Identifier: EUPAS29845.