Factors Associated With Oral Anticoagulant Use in Patients With Atrial Fibrillation and Mental Disorders.

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Clinical Psychiatry Pub Date : 2024-01-03 DOI:10.4088/JCP.23m14824

Dina Farran, Matthew Broadbent, Aikaterini Dima, Mark Ashworth, Fiona Gaughran

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引用次数: 0

Abstract

Objective: This study aims to identify how mental illness severity interacts with oral anticoagulant (OAC) patterns among people with atrial fibrillation (AF).

Methods: AF patients with comorbid mental illness (classified using ICD-10) were identified from the South London and Maudsley Biomedical Research Centre Case Register. CHA₂DS₂-VASc and ORBIT scales were used to calculate stroke and bleeding risks, respectively, whereas Health of the Nation Outcome Scales (HoNOS) assessment was used for functional impairment.

Results: Overall, 2,105 AF patients were identified between 2011 and 2019. Serious mental illness (SMI) was associated with lower prescription of any OAC (adjusted risk ratio [aRR]: 0.94; 95% CI, 0.90-0.99). A total of 62% of SMI patients at risk of stroke were not prescribed an OAC. In the AF cohort, alcohol or substance dependence and activities of daily living (ADL) impairment were associated with lower prescription of warfarin (aRR: 0.92; 95% CI, 0.86-0.98 and aRR: 0.96; 95% CI, 0.93-0.99, respectively). Among people with AF and SMI, warfarin was less likely to be prescribed to people with self-injury (aRR: 0.84; 95% CI, 0.77-0.91), hallucinations or delusions (aRR: 0.92; 95% CI, 0.85-0.99), ADL impairment (aRR: 0.91; 95% CI, 0.84-0.99), or alcohol or substance dependence (aRR: 0.92; 95% CI, 0.87-0.98). Among people with AF and comorbid substance use disorder, self-injury (aRR: 0.78; 95% CI, 0.64-0.96), cognitive problems (aRR: 0.84; 95% CI, 0.70-0.99), and other mental illnesses (aRR: 0.83; 95% CI, 0.70-0.99) were associated with lower prescription of warfarin.

Conclusions: An OAC treatment gap for AF patients with comorbid SMI relative to other mental illnesses was identified. The gap was wider in those with dependence comorbidities, positive symptoms, self-injury, or functional impairment.

J Clin Psychiatry 2024;85(1):23m14824.

Author affiliations are listed at the end of this article.

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心房颤动和精神障碍患者使用口服抗凝剂的相关因素。

目的：本研究旨在确定房颤患者的精神疾病严重程度与口服抗凝剂（OAC）模式之间的相互作用：本研究旨在确定心房颤动（房颤）患者的精神疾病严重程度与口服抗凝剂（OAC）模式之间的相互作用：方法：从南伦敦和莫兹利生物医学研究中心病例登记册中筛选出合并精神疾病的心房颤动患者（使用 ICD-10 进行分类）。CHA2DS2-VASc和ORBIT量表分别用于计算中风和出血风险，而国民健康结果量表（HoNOS）评估用于计算功能障碍：2011年至2019年期间，共发现2105名房颤患者。严重精神疾病（SMI）与较低的任何 OAC 处方相关（调整风险比 [aRR]：0.94；95% CI，0.90-0.99）。在有中风风险的 SMI 患者中，共有 62% 的人未被处方 OAC。在心房颤动队列中，酒精或药物依赖以及日常生活活动（ADL）障碍与华法林处方量较低有关（aRR：0.92；95% CI，0.86-0.98 和 aRR：0.96；95% CI，0.93-0.99）。在房颤患者和 SMI 患者中，华法林处方给自伤（aRR：0.84；95% CI：0.77-0.91）、幻觉或妄想（aRR：0.92；95% CI：0.85-0.99）、ADL 功能障碍（aRR：0.91；95% CI：0.84-0.99）、酒精或药物依赖（aRR：0.92；95% CI：0.87-0.98）患者的可能性较低。在心房颤动并合并药物使用障碍的患者中，自我伤害（aRR：0.78；95% CI，0.64-0.96）、认知问题（aRR：0.84；95% CI，0.70-0.99）和其他精神疾病（aRR：0.83；95% CI，0.70-0.99）与华法林处方量减少有关：结论：与其他精神疾病相比，合并 SMI 的房颤患者存在 OAC 治疗缺口。临床精神病学杂志》2024;85(1):23m14824。作者单位列于本文末尾。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Psychiatry 医学-精神病学

CiteScore

7.40

自引率

1.90%

发文量

审稿时长

3-8 weeks

期刊介绍： For over 75 years, The Journal of Clinical Psychiatry has been a leading source of peer-reviewed articles offering the latest information on mental health topics to psychiatrists and other medical professionals.The Journal of Clinical Psychiatry is the leading psychiatric resource for clinical information and covers disorders including depression, bipolar disorder, schizophrenia, anxiety, addiction, posttraumatic stress disorder, and attention-deficit/hyperactivity disorder while exploring the newest advances in diagnosis and treatment.