Mental Health Conditions and Nonpersistence of Direct Oral Anticoagulant Use in Patients With Incident Atrial Fibrillation: A Nationwide Cohort Study
Background Mental health conditions (MHCs) are associated with poor outcomes in patients with atrial fibrillation. However, persistence of oral anticoagulation therapy in patients with atrial fibrillation and MHCs is unknown. We aimed to evaluate the effect of MHCs on the persistence of direct oral...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.024119 |
| _version_ | 1797859020275449856 |
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| author | Konsta Teppo Jussi Jaakkola K. E. Juhani Airaksinen Fausto Biancari Olli Halminen Jukka Putaala Pirjo Mustonen Jari Haukka Juha Hartikainen Alex Luojus Mikko Niemi Miika Linna Mika Lehto |
| author_facet | Konsta Teppo Jussi Jaakkola K. E. Juhani Airaksinen Fausto Biancari Olli Halminen Jukka Putaala Pirjo Mustonen Jari Haukka Juha Hartikainen Alex Luojus Mikko Niemi Miika Linna Mika Lehto |
| author_sort | Konsta Teppo |
| collection | DOAJ |
| description | Background Mental health conditions (MHCs) are associated with poor outcomes in patients with atrial fibrillation. However, persistence of oral anticoagulation therapy in patients with atrial fibrillation and MHCs is unknown. We aimed to evaluate the effect of MHCs on the persistence of direct oral anticoagulant (DOAC) use in patients with atrial fibrillation based on a nationwide cohort. Methods and Results The nationwide registry‐based FinACAF (Finnish Anticoagulation in Atrial Fibrillation) cohort included 67 503 patients with incident atrial fibrillation and indication for permanent oral anticoagulation (CHA2DS2‐VASc score >1 in men and >2 in women) starting DOAC therapy between 2011 and 2018. MHCs of interest were depression, bipolar disorder, anxiety disorder, schizophrenia, and composite of any MHC. The main outcome was nonpersistence of DOAC use, defined as the first 120‐day period without DOAC purchases after drug initiation. The mean age of the patients was 75.3±8.9 years, 53.6% were women, and the prevalence of any MHC was 17.8%. Persistence after 1 year from DOAC initiation was 79.3% in patients without MHCs and 77.2% in patients with any MHC, and after 2 years were 64.4% and 60.6%, respectively (P<0.001). Higher incidence of nonpersistence to DOACs was observed in all MHC categories: adjusted subdistribution hazard ratios, 1.16 (95% CI, 1.11–1.21) for any MHC, 1.32 (95% CI, 1.22–1.42) for depression, 1.44 (95% CI, 1.15–1.80) for bipolar disorder, 1.25 (95% CI, 1.11–1.41) for anxiety disorder, and 1.30 (95% CI, 1.02–1.64) for schizophrenia. However, patients with only anxiety disorder without other MHCs were not at higher risk of nonpersistence. Conclusions MHCs are associated with nonpersistence of DOAC use. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04645537. |
| first_indexed | 2024-04-09T21:22:44Z |
| format | Article |
| id | doaj.art-6fd6fc6955444b2188dba6148a8ca6a2 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-09T21:22:44Z |
| publishDate | 2022-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-6fd6fc6955444b2188dba6148a8ca6a22023-03-28T04:20:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-03-0111610.1161/JAHA.121.024119Mental Health Conditions and Nonpersistence of Direct Oral Anticoagulant Use in Patients With Incident Atrial Fibrillation: A Nationwide Cohort StudyKonsta Teppo0Jussi Jaakkola1K. E. Juhani Airaksinen2Fausto Biancari3Olli Halminen4Jukka Putaala5Pirjo Mustonen6Jari Haukka7Juha Hartikainen8Alex Luojus9Mikko Niemi10Miika Linna11Mika Lehto12Faculty of Medicine University of Turku Turku FinlandFaculty of Medicine University of Turku Turku FinlandFaculty of Medicine University of Turku Turku FinlandClinica Montevergine Gruppo Villa Maria Care & Research Mercogliano ItalyDepartment of Industrial Engineering and Management Aalto University Espoo FinlandDepartment of Neurology Helsinki University Hospital Helsinki FinlandFaculty of Medicine University of Turku Turku FinlandFaculty of Medicine University of Helsinki FinlandFaculty of Medicine University of Eastern Finland Kuopio FinlandHeart and Lung Center Helsinki University Hospital Helsinki FinlandDepartment of Clinical Pharmacology University of Helsinki FinlandDepartment of Industrial Engineering and Management Aalto University Espoo FinlandHeart and Lung Center Helsinki University Hospital Helsinki FinlandBackground Mental health conditions (MHCs) are associated with poor outcomes in patients with atrial fibrillation. However, persistence of oral anticoagulation therapy in patients with atrial fibrillation and MHCs is unknown. We aimed to evaluate the effect of MHCs on the persistence of direct oral anticoagulant (DOAC) use in patients with atrial fibrillation based on a nationwide cohort. Methods and Results The nationwide registry‐based FinACAF (Finnish Anticoagulation in Atrial Fibrillation) cohort included 67 503 patients with incident atrial fibrillation and indication for permanent oral anticoagulation (CHA2DS2‐VASc score >1 in men and >2 in women) starting DOAC therapy between 2011 and 2018. MHCs of interest were depression, bipolar disorder, anxiety disorder, schizophrenia, and composite of any MHC. The main outcome was nonpersistence of DOAC use, defined as the first 120‐day period without DOAC purchases after drug initiation. The mean age of the patients was 75.3±8.9 years, 53.6% were women, and the prevalence of any MHC was 17.8%. Persistence after 1 year from DOAC initiation was 79.3% in patients without MHCs and 77.2% in patients with any MHC, and after 2 years were 64.4% and 60.6%, respectively (P<0.001). Higher incidence of nonpersistence to DOACs was observed in all MHC categories: adjusted subdistribution hazard ratios, 1.16 (95% CI, 1.11–1.21) for any MHC, 1.32 (95% CI, 1.22–1.42) for depression, 1.44 (95% CI, 1.15–1.80) for bipolar disorder, 1.25 (95% CI, 1.11–1.41) for anxiety disorder, and 1.30 (95% CI, 1.02–1.64) for schizophrenia. However, patients with only anxiety disorder without other MHCs were not at higher risk of nonpersistence. Conclusions MHCs are associated with nonpersistence of DOAC use. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04645537.https://www.ahajournals.org/doi/10.1161/JAHA.121.024119atrial fibrillationdepressiondirect oral anticoagulantsmental health conditionspersistence |
| spellingShingle | Konsta Teppo Jussi Jaakkola K. E. Juhani Airaksinen Fausto Biancari Olli Halminen Jukka Putaala Pirjo Mustonen Jari Haukka Juha Hartikainen Alex Luojus Mikko Niemi Miika Linna Mika Lehto Mental Health Conditions and Nonpersistence of Direct Oral Anticoagulant Use in Patients With Incident Atrial Fibrillation: A Nationwide Cohort Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation depression direct oral anticoagulants mental health conditions persistence |
| title | Mental Health Conditions and Nonpersistence of Direct Oral Anticoagulant Use in Patients With Incident Atrial Fibrillation: A Nationwide Cohort Study |
| title_full | Mental Health Conditions and Nonpersistence of Direct Oral Anticoagulant Use in Patients With Incident Atrial Fibrillation: A Nationwide Cohort Study |
| title_fullStr | Mental Health Conditions and Nonpersistence of Direct Oral Anticoagulant Use in Patients With Incident Atrial Fibrillation: A Nationwide Cohort Study |
| title_full_unstemmed | Mental Health Conditions and Nonpersistence of Direct Oral Anticoagulant Use in Patients With Incident Atrial Fibrillation: A Nationwide Cohort Study |
| title_short | Mental Health Conditions and Nonpersistence of Direct Oral Anticoagulant Use in Patients With Incident Atrial Fibrillation: A Nationwide Cohort Study |
| title_sort | mental health conditions and nonpersistence of direct oral anticoagulant use in patients with incident atrial fibrillation a nationwide cohort study |
| topic | atrial fibrillation depression direct oral anticoagulants mental health conditions persistence |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.024119 |
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