Abstract 10464: Mental Health Conditions Are Associated with Underuse of Oral Anticoagulation Therapy in Patients with Atrial Fibrillation: The FinACAF Study

Abstract

Introduction: Little is known about the effects of mental health conditions (MHC) on the utilization of oral anticoagulant (OAC) therapy in patients with atrial fibrillation (AF). We assessed the hypothesis that MHCs are associated with a lower rate of OAC initiation in patients with incident AF. Methods: The FinACAF registry included all 239 756 patients with incident AF during 2007-2018 in Finland identified from national 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 outcome OAC initiation (first fulfilled OAC prescription after AF diagnosis). Results: The patients’ mean age was 72.6 years (SD 13.2), 49.7% were female and 95.0% had CHA 2 DS 2 -VASc score ≥1. The prevalence of any MHC was 19.9%. A lower rate of OAC initiation was observed in patients with any MCH than in those without MHC (64.9% vs. 73.1%, p<0.001) during the entire follow-up. Any MHC was associated with lower cumulative incidence of OAC initiation (adjusted subdistribution hazard ratio (aSHR) 0.783; 95% CI 0.774-0.794, Figure) during the entire follow-up, as were depression (aSHR 0.833; 95% CI 0.813-0.852), bipolar disorder (aSHR 0.807; 95% CI 0.778-0.838), anxiety disorder (aSHR 0.816; 95% CI 0.758-0.878) and schizophrenia (aSHR 0.743; 95% CI 0.698-0.792) individually. By 2018, 89.9% of OAC initiations were with a non-vitamin K antagonist oral anticoagulant (NOAC) in patients with any MHC and 92.4% in patients with no MHC. Any MHC remained associated with impaired cumulative incidence of OAC initiation also in the NOAC-era during 2015-2018 (aSHR 0.821; 95% CI 0.805-0.837). Conclusions: MHCs are common among AF patients, and they are associated with a lower rate of OAC initiation even during the NOAC-era.