Mental health conditions and risk of first-ever ischaemic stroke and death in patients with incident atrial fibrillation: A nationwide cohort study.
atrial fibrillation
ischaemic stroke
mental health conditions
mortality
psychiatric disorders
Journal
European journal of clinical investigation
ISSN: 1365-2362
Titre abrégé: Eur J Clin Invest
Pays: England
ID NLM: 0245331
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
revised:
22
04
2022
received:
11
02
2022
accepted:
27
04
2022
pubmed:
30
4
2022
medline:
20
8
2022
entrez:
29
4
2022
Statut:
ppublish
Résumé
Atrial fibrillation (AF) patients with mental health conditions (MHCs) have higher incidence of ischaemic stroke (IS) than patients without MHC, but whether this results from direct impact of MHCs or relates to higher prevalence of comorbidities and differences in the use of oral anticoagulant (OAC) therapy is unclear. We assessed the hypothesis that MHCs independently increase the risk of IS in patients with incident AF. The nationwide FinACAF cohort covered all 203,154 patients diagnosed with incident AF without previous IS or transient ischaemic attack in Finland during 2007-2018. MHCs of interest were depression, bipolar disorder, anxiety disorder, schizophrenia and any MHC. The outcomes were first-ever IS and all-cause death. The patients' (mean age 73.0 ± 13.5 years, 49.0% female) mean follow-up time was 4.3 (SD 3.3) years and 16,272 (8.0%) experienced first-ever IS and 63,420 (31.2%) died during follow-up. After propensity score matching and adjusting for OAC use, no MHC group was associated with increased IS risk (adjusted SHRs (95% CI): depression 0.961 (0.857-1.077), bipolar disorder 1.398 (0.947-2.006), anxiety disorder 0.878 (0.718-1.034), schizophrenia 0.803 (0.594-1.085) and any MHC 1.033 (0.985-1.085)). Lower rate of OAC use partly explained the observed higher crude IS incidence in patients with any MHC. Depression, schizophrenia and any MHC were associated with higher all-cause mortality (adjusted HRs [95% CI]: 1.208 [1.136-1.283], 1.543 [1.352-1.761] and 1.149 [1.116-1.175], respectively). In this nationwide retrospective cohort study, MHCs were not associated with the incidence of first-ever IS in patients with AF.
Sections du résumé
BACKGROUND
BACKGROUND
Atrial fibrillation (AF) patients with mental health conditions (MHCs) have higher incidence of ischaemic stroke (IS) than patients without MHC, but whether this results from direct impact of MHCs or relates to higher prevalence of comorbidities and differences in the use of oral anticoagulant (OAC) therapy is unclear. We assessed the hypothesis that MHCs independently increase the risk of IS in patients with incident AF.
METHODS
METHODS
The nationwide FinACAF cohort covered all 203,154 patients diagnosed with incident AF without previous IS or transient ischaemic attack in Finland during 2007-2018. MHCs of interest were depression, bipolar disorder, anxiety disorder, schizophrenia and any MHC. The outcomes were first-ever IS and all-cause death.
RESULTS
RESULTS
The patients' (mean age 73.0 ± 13.5 years, 49.0% female) mean follow-up time was 4.3 (SD 3.3) years and 16,272 (8.0%) experienced first-ever IS and 63,420 (31.2%) died during follow-up. After propensity score matching and adjusting for OAC use, no MHC group was associated with increased IS risk (adjusted SHRs (95% CI): depression 0.961 (0.857-1.077), bipolar disorder 1.398 (0.947-2.006), anxiety disorder 0.878 (0.718-1.034), schizophrenia 0.803 (0.594-1.085) and any MHC 1.033 (0.985-1.085)). Lower rate of OAC use partly explained the observed higher crude IS incidence in patients with any MHC. Depression, schizophrenia and any MHC were associated with higher all-cause mortality (adjusted HRs [95% CI]: 1.208 [1.136-1.283], 1.543 [1.352-1.761] and 1.149 [1.116-1.175], respectively).
CONCLUSIONS
CONCLUSIONS
In this nationwide retrospective cohort study, MHCs were not associated with the incidence of first-ever IS in patients with AF.
Identifiants
pubmed: 35484936
doi: 10.1111/eci.13801
pmc: PMC9539593
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13801Subventions
Organisme : Aarne Koskelon Säätiö
Organisme : Helsingin ja Uudenmaan Sairaanhoitopiiri
Organisme : Sydäntutkimussäätiö
Informations de copyright
© 2022 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.
Références
Eur Heart J. 2021 Feb 1;42(5):546-547
pubmed: 33242070
Ann Intern Med. 2007 Jun 19;146(12):857-67
pubmed: 17577005
Am J Prev Cardiol. 2021 Jun 27;7:100221
pubmed: 34611647
JAMA. 2000 Nov 22-29;284(20):2606-10
pubmed: 11086367
Herz. 2021 Mar;46(2):138-149
pubmed: 33544152
Eur J Epidemiol. 1997 Feb;13(2):133-8
pubmed: 9084994
Schizophr Res. 2018 Sep;199:109-115
pubmed: 29555213
Eur J Cardiovasc Prev Rehabil. 2007 Jun;14(3):380-5
pubmed: 17568236
World Psychiatry. 2011 Feb;10(1):52-77
pubmed: 21379357
Geroscience. 2018 Jun 22;:
pubmed: 29934733
JAMA. 2000 Jan 26;283(4):506-11
pubmed: 10659877
Psychosom Med. 2010 Jan;72(1):9-15
pubmed: 19995887
Eur Heart J. 2013 Sep;34(35):2746-51
pubmed: 23900699
Lancet Psychiatry. 2022 Feb;9(2):137-150
pubmed: 35026139
BMJ Open. 2017 Dec 06;7(12):e018209
pubmed: 29217725
Eur J Clin Invest. 2010 Jan;40(1):35-53
pubmed: 20055895
J Psychosom Res. 2000 Apr-May;48(4-5):455-62
pubmed: 10880666
Schizophr Res. 2018 Feb;192:113-118
pubmed: 28499768
Eur J Clin Invest. 2022 Sep;52(9):e13801
pubmed: 35484936
Int J Cardiol. 2014 May 15;173(3):588-90
pubmed: 24698235
Eur Heart J Qual Care Clin Outcomes. 2022 May 5;8(3):269-276
pubmed: 34677571
Eur J Epidemiol. 2022 Jan;37(1):95-102
pubmed: 34985732
Eur Psychiatry. 2017 Mar;41:102-108
pubmed: 28135591
BMC Med. 2021 Mar 22;19(1):67
pubmed: 33745445
Neurol Sci. 2022 Jan;43(1):467-476
pubmed: 34052937
Br J Psychiatry. 2017 Sep;211(3):175-181
pubmed: 28684403
PLoS One. 2013;8(1):e55176
pubmed: 23372832
JAMA. 2011 Sep 21;306(11):1241-9
pubmed: 21934057
PLoS One. 2018 Dec 26;13(12):e0209687
pubmed: 30586468
Am J Psychiatry. 2002 Sep;159(9):1584-90
pubmed: 12202281
Scand J Public Health. 2012 Aug;40(6):505-15
pubmed: 22899561
Eur Heart J Qual Care Clin Outcomes. 2021 Oct 28;7(6):574-582
pubmed: 32735316
J Gen Intern Med. 2005 Dec;20(12):1114-9
pubmed: 16423100