Anxiety, Depression, and Adverse Clinical Outcomes in Patients With Atrial Fibrillation Starting Warfarin: Cardiovascular Research Network WAVE Study

Baumgartner, Christine; Fan, Dongjie; Fang, Margaret C.; Singer, Daniel E.; Witt, Daniel M.; Schmelzer, John R.; Williams, Marc S.; Gurwitz, Jerry H.; Sung, Sue Hee; Go, Alan S.

doi:10.1161/jaha.117.007814

Cited by 33 publications

(37 citation statements)

References 48 publications

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“…Diagnosed depression and anxiety disorder were associated with a greater risk of both ischemic stroke and intracranial hemorrhage. 37 It is unclear whether depression contributes to FS or vice versa, or if both disorders co-occur in the same patients independently of one another, but research confirms the pathophysiological processes and biomarkers present in both. The present study corroborates the available literature data.…”

Section: Discussionmentioning

confidence: 99%

<p>Assessment of Frailty and Occurrence of Anxiety and Depression in Elderly Patients with Atrial Fibrillation</p>

Uchmanowicz¹,

Lomper²,

Gros³

et al. 2020

CIA

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Purpose: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its incidence increases with age. The elderly population is commonly affected by frailty syndrome (FS). FS syndrome along with anxiety and depressive symptoms are prevalent among elderly patients with AF. It is unclear whether depression contributes to AF or vice versa. The purpose of this study was to assess correlations between FS and the occurrence of anxiety and depression symptoms in a group of elderly patients with AF. Patients and Methods: This cross-sectional study included 100 elderly patients (69 females, 31 males, mean age: 70.27 years) with AF. Standardized research instruments were used including the Tilburg Frailty Indicator (TFI) to assess FS, and two questionnaires to assess depression including the Geriatric Depression Scale (GDS), and the Hospital Anxiety Depression Scale (HADS). Results: Mild FS was found in 38% and moderate FS in 29% of patients. Based on GDS scores, depression symptoms were found in 51% of patients' sample. Based on HADS scores, 20% of patients were found to have anxiety symptoms, and 28% revealed depression symptoms. Single-factor analysis demonstrated a significant positive correlation between HADS anxiety symptoms (r=0.492), HADS depression symptoms (r=0.696), and GDS score (r=0.673) on the one hand, and overall TFI frailty score on the other. Multiple-factor analysis identified overall GDS score, education, and lack of bleeding as significant independent predictors of TFI scores (p<0.05). Conclusion: FS is common in the population of elderly patients with AF. We found evidence for the association between symptoms of anxiety and depression and the incidence of FS in this group of patients. Due to the risk of consequences which may in part be irreversible, screening for FS is recommended.

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Section: Discussionmentioning

confidence: 99%

<p>Assessment of Frailty and Occurrence of Anxiety and Depression in Elderly Patients with Atrial Fibrillation</p>

Uchmanowicz¹,

Lomper²,

Gros³

et al. 2020

CIA

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“…Anxiety is also independently associated with 50% higher risk of stroke and intracranial hemorrhage in AF patients initiating warfarin. This suggests in aggregate that conditions common in geriatric patients influence anticoagulation adherence as well as effectiveness …”

Section: Discussionmentioning

confidence: 99%

“…This suggests in aggregate that conditions common in geriatric patients influence anticoagulation adherence as well as effectiveness. 8 Anticoagulation satisfaction is an important patient-reported outcome because it is strongly associated with anticoagulation adherence and clinical outcomes, including bleeding and stroke. [24][25][26] The previous literature on anticoagulation satisfaction in AF has generally focused on comparing satisfaction among warfarin-treated patients to those treated with DOACs in whom the burden from anticoagulation treatment is generally lower.…”

Section: Discussionmentioning

confidence: 99%

“…Physical, cognitive, and psychosocial conditions have strong prognostic value in AF. Depression and anxiety are independently associated with ischemic stroke and intracranial bleeding in patients with AF . Also, impaired cognition is a risk factor for warfarin instability .…”

Section: Introductionmentioning

confidence: 99%

“…Depression and anxiety are independently associated with ischemic stroke and intracranial bleeding in patients with AF. 8 Also, impaired cognition is a risk factor for warfarin instability. 9,10 However, whether these conditions are associated with anticoagulation satisfaction in patients with AF is unclear.…”

Section: Introductionmentioning

confidence: 99%

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Physical, cognitive, and psychosocial conditions in relation to anticoagulation satisfaction among elderly adults with atrial fibrillation: The SAGE‐AF study

Wang

Saczynski

Lessard

et al. 2019

Cardiovasc electrophysiol

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Background Successful anticoagulation is critical for stroke prevention in adults with atrial fibrillation (AF). Anticoagulation satisfaction is a key indicator of treatment success. While physical, cognitive, and psychosocial limitations are common in elderly AF patients, their associations with anticoagulation satisfaction are unknown. Objective Examine whether anticoagulation satisfaction differs among AF patients with and without physical, cognitive, and psychosocial conditions. Methods The study comprised AF patients greater than or equal to 65 years old who were prescribed an oral anticoagulant (warfarin 57%; direct oral anticoagulant [DOAC] 43%). Frailty, cognitive function, social support, depressive symptoms, vision, hearing, and anxiety were assessed using validated measures. Anticoagulation satisfaction was measured using the anticlot treatment scale. Results Participants (n = 1037, 50% female) were on average 76 years old. The following conditions were prevalent: frailty (14%), cognitive impairment (42%), social isolation (13%), vision impairment (35%), hearing impairment (36%), depression (29%), and anxiety (24%). Average anticlot treatment burden scale was 55 out of 60 (lower burden scales indicating higher perceived burden). Patients with high perceived burden were older, more likely to be female, and receive warfarin. After adjusting for confounders, visual impairment (adjusted odds ratio [95% confidence interval]: 1.7 [1.2‐2.4]), depressive symptoms (2.4 [1.6‐3.7]), and anxiety (1.8 [1.2‐2.7]) were significantly associated with high perceived burden. Different conditions were associated with high perceived burden in warfarin vs DOAC users. Conclusion Physical, cognitive, and psychosocial limitations are prevalent and associated with high perceived anticoagulation burden among elderly AF adults. These conditions merit consideration in anticoagulation prescribing.

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Concomitant Use of Selective Serotonin Reuptake Inhibitors With Oral Anticoagulants and Risk of Major Bleeding

Rahman,

Platt,

Beradid

et al. 2024

JAMA Netw Open

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ImportanceSelective serotonin reuptake inhibitors (SSRIs) are commonly prescribed antidepressants associated with a small increased risk of major bleeding. However, the risk of bleeding associated with the concomitant use of SSRIs and oral anticoagulants (OACs) has not been well characterized.ObjectivesTo assess whether concomitant use of SSRIs with OACs is associated with an increased risk of major bleeding compared with OAC use alone, describe how the risk varies with duration of use, and identify key clinical characteristics modifying this risk.Design, Setting, and ParticipantsA population-based, nested case-control study was conducted among patients with atrial fibrillation initiating OACs between January 2, 1998, and March 29, 2021. Patients were from approximately 2000 general practices in the UK contributing to the Clinical Practice Research Datalink. With the use of risk-set sampling, for each case of major bleeding during follow-up, up to 30 controls were selected from risk sets defined by the case and matched on age, sex, cohort entry date, and follow-up duration.ExposuresConcomitant use of SSRIs and OACs (direct OACs and vitamin K antagonists [VKAs]) compared with OAC use alone.Main Outcomes and MeasuresThe main outcome was incidence rate ratios (IRRs) of hospitalization for bleeding or death due to bleeding.ResultsThere were 42 190 patients with major bleeding (mean [SD] age, 74.2 [9.3] years; 59.8% men) matched to 1 156 641 controls (mean [SD] age, 74.2 [9.3] years; 59.8% men). Concomitant use of SSRIs and OACs was associated with an increased risk of major bleeding compared with OACs alone (IRR, 1.33; 95% CI, 1.24-1.42). The risk peaked during the initial months of treatment (first 30 days of use: IRR, 1.74; 95% CI, 1.37-2.22) and persisted for up to 6 months. The risk did not vary with age, sex, history of bleeding, chronic kidney disease, and potency of SSRIs. An association was present both with concomitant use of SSRIs and direct OACs compared with direct OAC use alone (IRR, 1.25; 95% CI, 1.12-1.40) and concomitant use of SSRIs and VKAs compared with VKA use alone (IRR, 1.36; 95% CI, 1.25-1.47).Conclusions and RelevanceThis study suggests that among patients with atrial fibrillation, concomitant use of SSRIs and OACs was associated with an increased risk of major bleeding compared with OAC use alone, requiring close monitoring and management of risk factors for bleeding, particularly in the first few months of use.

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Anxiety, Depression, and Adverse Clinical Outcomes in Patients With Atrial Fibrillation Starting Warfarin: Cardiovascular Research Network WAVE Study

Cited by 33 publications

References 48 publications

<p>Assessment of Frailty and Occurrence of Anxiety and Depression in Elderly Patients with Atrial Fibrillation</p>

<p>Assessment of Frailty and Occurrence of Anxiety and Depression in Elderly Patients with Atrial Fibrillation</p>

Physical, cognitive, and psychosocial conditions in relation to anticoagulation satisfaction among elderly adults with atrial fibrillation: The SAGE‐AF study

Concomitant Use of Selective Serotonin Reuptake Inhibitors With Oral Anticoagulants and Risk of Major Bleeding

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