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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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.
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