The impact of mental health conditions on oral anticoagulation therapy and outcomes in patients with atrial fibrillation: A systematic review and meta-analysis
One third of patients with atrial fibrillation (AF) are estimated to suffer from mental health conditions (MHCs). We conducted a systematic review and meta-analysis to investigate the impact of MHCs on the prevalence and quality of oral anticoagulation (OAC) therapy and outcomes in patients with AF....
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doaj-9f158f2a3c584e4d910d6073fb0866822021-08-24T04:07:56ZengElsevierAmerican Journal of Preventive Cardiology2666-66772021-09-017100221The impact of mental health conditions on oral anticoagulation therapy and outcomes in patients with atrial fibrillation: A systematic review and meta-analysisKonsta Teppo0Jussi Jaakkola1Mika Lehto2Fausto Biancari3K.E. Juhani Airaksinen4Heart Center, Turku University Hospital, and University of Turku, Turku, FinlandHeart Center, Turku University Hospital, and University of Turku, Turku, Finland; Correspondence to: Satakunta Central Hospital, Pori, Finland, Sairaalantie 3, FIN-28500 Pori, Finland.Lohja Hospital, Department of Internal Medicine, Lohja, Finland; Heart and Lung Center, Helsinki University Hospital, and University of Helsinki, Helsinki, FinlandHeart and Lung Center, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland; Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, FinlandHeart Center, Turku University Hospital, and University of Turku, Turku, FinlandOne third of patients with atrial fibrillation (AF) are estimated to suffer from mental health conditions (MHCs). We conducted a systematic review and meta-analysis to investigate the impact of MHCs on the prevalence and quality of oral anticoagulation (OAC) therapy and outcomes in patients with AF. Medline database was searched for studies published before March 1st 2021 evaluating AF patients with comorbid MHCs reporting on the prevalence of OAC therapy, time in therapeutic range (TTR) in warfarin-receiving patients, adherence to OAC therapy or adverse outcomes (ischemic stroke, hemorrhage or mortality). Studies reporting on outcome events were included in the meta-analysis. The literature search yielded 17 studies including 977,535 patients that fulfilled the inclusion criteria of this review. AF patients with MHCs had a lower prevalence of OAC use and poorer TTR compared with patients without MHCs. Evidence on OAC quality in patients receiving direct oral anticoagulants (DOACs) was minimal and inconclusive. A decrease in depression-associated deficit in OAC prevalence was observed after the introduction of DOACs. Pooled analysis of five studies reporting on outcomes showed that MHCs were an independent risk factor for both stroke (RR 1.25, 95%CI 1.08–1.45, I2 0%) and major bleeding (RR 1.17, 95%CI 1.08–1.27, I2 27%). Data on mortality were lacking and therefore not included in the meta-analysis. Evidence on the impact of specific MHCs on the outcomes were inadequate. In conclusion, MHCs are independent risk factors for stroke and major bleeding in patients with AF. Future studies are needed to confirm the findings of this meta-analysis, to evaluate the prognostic impact of different MHCs and to clarify whether the introduction of DOACs might have improved the outcomes of these patients.http://www.sciencedirect.com/science/article/pii/S2666667721000763Atrial fibrillationOral anticoagulationMental healthPsychiatry |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Konsta Teppo Jussi Jaakkola Mika Lehto Fausto Biancari K.E. Juhani Airaksinen |
spellingShingle |
Konsta Teppo Jussi Jaakkola Mika Lehto Fausto Biancari K.E. Juhani Airaksinen The impact of mental health conditions on oral anticoagulation therapy and outcomes in patients with atrial fibrillation: A systematic review and meta-analysis American Journal of Preventive Cardiology Atrial fibrillation Oral anticoagulation Mental health Psychiatry |
author_facet |
Konsta Teppo Jussi Jaakkola Mika Lehto Fausto Biancari K.E. Juhani Airaksinen |
author_sort |
Konsta Teppo |
title |
The impact of mental health conditions on oral anticoagulation therapy and outcomes in patients with atrial fibrillation: A systematic review and meta-analysis |
title_short |
The impact of mental health conditions on oral anticoagulation therapy and outcomes in patients with atrial fibrillation: A systematic review and meta-analysis |
title_full |
The impact of mental health conditions on oral anticoagulation therapy and outcomes in patients with atrial fibrillation: A systematic review and meta-analysis |
title_fullStr |
The impact of mental health conditions on oral anticoagulation therapy and outcomes in patients with atrial fibrillation: A systematic review and meta-analysis |
title_full_unstemmed |
The impact of mental health conditions on oral anticoagulation therapy and outcomes in patients with atrial fibrillation: A systematic review and meta-analysis |
title_sort |
impact of mental health conditions on oral anticoagulation therapy and outcomes in patients with atrial fibrillation: a systematic review and meta-analysis |
publisher |
Elsevier |
series |
American Journal of Preventive Cardiology |
issn |
2666-6677 |
publishDate |
2021-09-01 |
description |
One third of patients with atrial fibrillation (AF) are estimated to suffer from mental health conditions (MHCs). We conducted a systematic review and meta-analysis to investigate the impact of MHCs on the prevalence and quality of oral anticoagulation (OAC) therapy and outcomes in patients with AF. Medline database was searched for studies published before March 1st 2021 evaluating AF patients with comorbid MHCs reporting on the prevalence of OAC therapy, time in therapeutic range (TTR) in warfarin-receiving patients, adherence to OAC therapy or adverse outcomes (ischemic stroke, hemorrhage or mortality). Studies reporting on outcome events were included in the meta-analysis. The literature search yielded 17 studies including 977,535 patients that fulfilled the inclusion criteria of this review. AF patients with MHCs had a lower prevalence of OAC use and poorer TTR compared with patients without MHCs. Evidence on OAC quality in patients receiving direct oral anticoagulants (DOACs) was minimal and inconclusive. A decrease in depression-associated deficit in OAC prevalence was observed after the introduction of DOACs. Pooled analysis of five studies reporting on outcomes showed that MHCs were an independent risk factor for both stroke (RR 1.25, 95%CI 1.08–1.45, I2 0%) and major bleeding (RR 1.17, 95%CI 1.08–1.27, I2 27%). Data on mortality were lacking and therefore not included in the meta-analysis. Evidence on the impact of specific MHCs on the outcomes were inadequate. In conclusion, MHCs are independent risk factors for stroke and major bleeding in patients with AF. Future studies are needed to confirm the findings of this meta-analysis, to evaluate the prognostic impact of different MHCs and to clarify whether the introduction of DOACs might have improved the outcomes of these patients. |
topic |
Atrial fibrillation Oral anticoagulation Mental health Psychiatry |
url |
http://www.sciencedirect.com/science/article/pii/S2666667721000763 |
work_keys_str_mv |
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