Atrial fibrillation in patients with severe mental disorders and the risk of stroke, fatal thromboembolic events and bleeding: a nationwide cohort study.

Abstract

OBJECTIVES:

Outcomes of atrial fibrillation (AF) in patients with severe mental disorders are largely unknown. We compared rates of stroke, fatal thromboembolic events and bleeding in patients with AF with and without mental disorders.

DESIGN:

Nationwide registry-based cohort study.

SETTING:

Denmark (population 5.6 million), 2000-2015.

PARTICIPANTS:

Patients with AF with schizophrenia (n=534), severe depression (n=400) or bipolar disease (n=569) matched 1:5 on age, sex and calendar time to patients with AF without mental disorders.

EXPOSURE:

Inpatient or hospital-based outpatient diagnosis of schizophrenia, severe depression or bipolar disease.

PRIMARY AND SECONDARY OUTCOME MEASURES:

HRs for stroke, fatal thromboembolic events and major bleeding comparing patients with and without mental disorders estimated by Cox regression with sequential adjustment for risk factors for stroke and bleeding, comorbidity and initiation of oral anticoagulant therapy (OAT).

RESULTS:

Compared with matched comparisons, crude 5-year HRs of ischaemic stroke were 1.37 (95% CI 0.88 to 2.14) for schizophrenia, 1.36 (95% CI 0.89 to 2.08) for depression and 1.04 (95% CI 0.69 to 1.56) for bipolar disease. After adjusting for risk factors, comorbidity and OAT, these HRs declined towards the null. Crude HRs of fatal thromboembolic events were 3.16 (95% CI 1.78 to 5.61) for schizophrenia, 1.31 (95% CI 0.67 to 2.56) for depression and 1.53 (95% CI 0.93 to 2.53) for bipolar disease. Rates of major bleeding were increased in patients with schizophrenia (crude HR 1.37, 95% CI 0.99 to 1.90) and severe depression (HR 1.25, 95% CI 0.87 to 1.78) but not bipolar disease (HR 0.82, 95% CI 0.58 to 1.15).

CONCLUSION:

Patients with AF with schizophrenia or severe depression experienced increased rates of stroke and major bleeding compared with matched comparisons. This increase was largely explained by differences in the prevalence of risk factors for stroke and bleeding, comorbidity and initiation of OAT during follow-up. Patients with AF with schizophrenia further experienced higher mortality following thromboembolic events than matched comparisons without mental disorders.

• Authors: Mette Søgaard, Flemming Skjøth, Jette Nordstrøm Kjældgaard, Torben Bjerregaard Larsen, Søren Pihlkjær Hjortshøj, Sam Riahi
• Journal: BMJ open (BMJ Open) Vol. 7 Issue 12 Pg. e018209 (Dec 06 2017) ISSN: 2044-6055 [Electronic] England
• PMID: 29217725 (Publication Type: Journal Article)
• Copyright: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Chemical References

• Anticoagulants

Topics

• Aged
• Anticoagulants (therapeutic use)
• Atrial Fibrillation (complications)
• Cohort Studies
• Denmark (epidemiology)
• Female
• Hemorrhage (epidemiology, etiology)
• Humans
• Male
• Mental Disorders (complications)
• Middle Aged
• Prevalence
• Risk Factors
• Stroke (epidemiology, etiology)
• Thromboembolism (epidemiology, etiology)