Depression or anxiety and all-cause mortality in adults with atrial fibrillation – A cohort study in Swedish primary care

Abstract

Objective Our aim was to study depression and anxiety in atrial fibrillation (AF) patients as risk factors for all-cause mortality in a primary care setting. Methods The study population included adults (n = 12 283) of 45 years and older diagnosed with AF in 75 primary care centres in Sweden. The association between depression or anxiety and all-cause mortality was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). Analyses were conducted in men and women, adjusted for age, educational level, marital status, neighborhood socio-economic status (SES), change of neighborhood status and anxiety or depression, respectively, and cardiovascular co-morbidities. As a secondary analysis, background factors and their association with depression or anxiety were explored. Results The risk of all-cause mortality was higher among men with depression compared to their counterparts without depression even after full adjustment (HR = 1.28, 95% CI 1.08–1.53). For anxiety among men and anxiety or depression among women with AF, no associations were found. Cerebrovascular disease was more common among depressed AF patients. Conclusions Increased awareness of the higher mortality among men with AF and subsequent depression is called for. We suggest a tight follow-up and treatment of both ailments in clinical practice.

The association between relevant comorbidities and dementia in patients with atrial fibrillation

“…For depression, women more often develop this mental disorder, but possibly men with depression could be affected to a larger degree. We have earlier found depression to be associated with increased mortality among men with AF, but not among women (Wandell et al 2016 ).…”

Anxiety and Depression in Patients with Permanent Atrial Fibrillation: Prevalence and Associated Factors

“…Accordingly, female may be more vulnerable to distress mainly those living alone as a result of being divorced/widowed or having comorbid conditions. Taking into consideration that women may have worse outcomes [ 22 ] or increased risk of death when compared to male counterparts (90% versus 50%), it becomes apparent that women should undergo diagnostic evaluation and anxiety alleviation [ 23 ].…”

Psychosocial and cognitive multimorbidity and health-related quality of life and symptom burden in older adults with atrial fibrillation: The systematic assessment of geriatric elements in atrial fibrillation (SAGE-AF) cohort study

“…With an estimated prevalence of 3–5 million adults, atrial fibrillation (AF) represents the most common cardiac rhythm abnormality. ( Wändell et al, 2016 ) Considering an aging population in the US and that AF primarily affects older adults, prevalence of AF is expected to more than double to 12 million by 2050. ( Go, Hylek, & Phillips, 2001 ; Wändell et al, 2016 ) Further, AF represents a significant economic burden with health-related costs about $8700 higher per year than those living without AF.…”

“…( Wändell et al, 2016 ) Considering an aging population in the US and that AF primarily affects older adults, prevalence of AF is expected to more than double to 12 million by 2050. ( Go, Hylek, & Phillips, 2001 ; Wändell et al, 2016 ) Further, AF represents a significant economic burden with health-related costs about $8700 higher per year than those living without AF. ( Roger, Go, & Lloyd-Jones, 2011 ) Treatment of AF by attempting restoration of sinus rhythm with cardioversions, anti-arrhythmic medications and catheter ablation has been shown to reduce symptoms and improve quality of life, but has no incremental benefits on stroke, bleeding or mortality.…”

“…Among patients with AF, it is estimated that 2 million patients also live with a psychosocial (i.e., depression or anxiety) or cognitive impairment. ( Akintade, Chapa, Friedmann, & Thomas, 2015 ; Thrall, Lip, Carroll, & Lane, 2007 ; Frasure-Smith, Lespérance, & Habra, 2009 Patients with psychosocial or cognitive impairments have poorer outcomes including a greater risk for cardiovascular events, increased healthcare utilization, increased symptom severity, poorer medication adherence, increased all-cause mortality ( Frasure-Smith et al, 2009 ; Wändell et al, 2016 ; Flaker, Pogue, & Yusuf, 2010 ; Thrall, Lip, Carroll, & Lane, 2007 ; Gehi, Sears, & Goli, 2012 and poorer HRQoL. ( Charitakis, Barmano, Walfridsson, & Walfridsson, 2017 ; Tan et al, 2018 ; Ong, Cribbie, & Harris, 2006 ; Akintade, Chapa, Friedmann, & Thomas, 2015 Although there is evidence that individual psychosocial and cognitive impairments may affect HRQoL and symptom burden in AF, little research has examined whether increased impairment (i.e., multi-morbidity) is associated with poorer clinical outcomes.…”