Abstract 10322: Mental Health Conditions Are Associated with Underuse of Rhythm Control Therapies in Patients with Atrial Fibrillation: The FinACAF Study

Abstract

Introduction: Mental health conditions (MHCs) have been associated with undertreatment of unrelated medical conditions, but whether patients with MHCs face disparities in receiving antiarrhythmic therapies (AATs) for atrial fibrillation (AF) is currently unknown. We assessed the hypothesis that MHCs are associated with decreased use of AATs. Methods: The FinACAF cohort included records on all AF patients in Finland during 2007-2018 identified from nationwide registries covering all levels of care as well as their drug purchases. The main exposure was any MHC (previous diagnosis of depression, bipolar disorder, anxiety disorder or schizophrenia or fulfilled prescription of psychiatric medication within preceding year from first AF diagnosis) and the main outcome was use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription. Results: We identified 239 222 patients with incident AF and the prevalence of any MHC was 19.9%. Mean age was 72.6 years (SD 13.2). Lower overall rate of any AAT use was observed in patients with any MHC than in those without MHC (16.9% vs. 22.9%, p<0.001). Cumulative five-year incidence curve of any AAT is presented in Figure 1. Any MHC was associated with decreased use of any AAT, AADs, cardioversion and catheter ablation (adjusted hazard ratios (aHR) 95% CI 0.804 (0.784-0.823), 0.870 (0.839-0.902), 0.784 (0.762-0.806) and 0.832 (0.771-0.899), respectively). Depression, bipolar disorder, anxiety disorder and schizophrenia were individually associated with decreased use of any AAT (aHR 95% CI 0.879 (0.837-0.922), 0.871 (0.760-0.998), 0.786 (0.731-0.845), and 0.423 (0.358-0.500), respectively). A lower rate of AAT use was observed in patients with MHC across the study period and no meaningful temporal change was noted in the MHC related deficit. Conclusions: MHCs are associated with decreased use of rhythm control therapies in patients with AF.