Mental health conditions and risk of first-ever ischaemic stroke and death in patients with incident atrial fibrillation: A nationwide cohort study
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A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
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en
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10
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European Journal of Clinical Investigation, Volume 52
Abstract
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: 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: 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: In this nationwide retrospective cohort study, MHCs were not associated with the incidence of first-ever IS in patients with AF.Description
Funding Information: Jukka Putaala: Dr. Putaala reports personal fees from Boehringer Ingelheim, personal fees and other from Bayer, grants and personal fees from BMS‐Pfizer, personal fees from Portola, other from Amgen, personal fees from Herantis Pharma, personal fees from Terve Media, other from Vital Signum, personal fees from Abbott, outside the submitted work. Pirjo Mustonen: Consultant: Roche, BMS‐Pfizer‐alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. Jari Haukka: Consultant: Research Janssen R&D; Speaker: Bayer Finland. Miika Linna: Speaker: BMS‐Pfizer‐alliance, Bayer, Boehringer Ingelheim. Juha Hartikainen: Research grants: The Finnish Foundation for Cardiovascular Research, EU Horizon 2020, EU FP7. Advisory Board Member: BMS‐Pfizer‐alliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. K.E. Juhani Airaksinen: Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer Ingelheim. Member in the advisory boards: Bayer, Pfizer and AstraZeneca. Mika Lehto: Consultant: BMS‐Pfizer‐alliance, Bayer, Boehringer Ingelheim, and MSD; Speaker: BMS‐Pfizer‐alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer Ingelheim. Aapo Aro: Research grants: Finnish Foundation for Cardiovascular Research; Speaker: Abbott, Johnson&Johnson, Sanofi, Bayer, Boehringer Ingelheim. Other authors: none. Funding Information: This work was supported by the Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research and Helsinki and Uusimaa Hospital District research fund (TYH2019309). Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication Publisher 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.
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Teppo, K, Jaakkola, J, Biancari, F, Halminen, O, Putaala, J, Mustonen, P, Haukka, J, Linna, M, Kinnunen, J, Tiili, P, Kouki, E, Penttilä, T, Hartikainen, J, Aro, A L, Airaksinen, K E J & Lehto, M 2022, 'Mental health conditions and risk of first-ever ischaemic stroke and death in patients with incident atrial fibrillation : A nationwide cohort study', European Journal of Clinical Investigation, vol. 52, 13801. https://doi.org/10.1111/eci.13801