Outcomes of Anticoagulation Therapy in Patients with Mental Health Conditions

Paradise, Helen T.; Berlowitz, Dan R.; Ozonoff, Al; Miller, Donald R.; Ash, Arlene S.; Jasuja, Guneet K.; Zhao, Shibei; Reisman, Joel I.; Rose, Adam J.

doi:10.1007/s11606-014-2784-2

Cited by 32 publications

(45 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent retrospective cohort study among >100 000 patients on warfarin (≥65 000 with AF) from the Veterans Health Administration found that the risk of hemorrhage was slightly higher in those with mental health disorders (such as depression) compared with those without mental health disorders 21. However, this previous study included only patients who were taking warfarin for at least 6 months and likely represented a selected subset of patients who tolerated anticoagulation better 22.…”

Section: Discussionmentioning

confidence: 99%

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

Baumgartner

Fan

Fang

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundAnxiety and depression are associated with worse outcomes in several cardiovascular conditions, but it is unclear whether they affect outcomes in atrial fibrillation (AF). In a large diverse population of adults with AF, we evaluated the association of diagnosed anxiety and/or depression with stroke and bleeding outcomes.Methods and ResultsThe Cardiovascular Research Network WAVE (Community‐Based Control and Persistence of Warfarin Therapy and Associated Rates and Predictors of Adverse Clinical Events in Atrial Fibrillation and Venous Thromboembolism) Study included adults with AF newly starting warfarin between 2004 and 2007 within 5 health delivery systems in the United States. Diagnosed anxiety and depression and other patient characteristics were identified from electronic health records. We identified stroke and bleeding outcomes from hospitalization databases using validated International Classification of Diseases, Ninth Revision (ICD‐9), codes. We used multivariable Cox regression to assess the relation between anxiety and/or depression with outcomes after adjustment for stroke and bleeding risk factors. In 25 570 adults with AF initiating warfarin, 490 had an ischemic stroke or intracranial hemorrhage (1.52 events per 100 person‐years). In multivariable analyses, diagnosed anxiety was associated with a higher adjusted rate of combined ischemic stroke and intracranial hemorrhage (hazard ratio, 1.52; 95% confidence interval, 1.01–2.28). Results were not materially changed after additional adjustment for patient‐level percentage of time in therapeutic anticoagulation range on warfarin (hazard ratio, 1.56; 95% confidence interval, 1.03–2.36). In contrast, neither isolated depression nor combined depression and anxiety were significantly associated with outcomes.ConclusionsDiagnosed anxiety was independently associated with increased risk of combined ischemic stroke and intracranial hemorrhage in adults with AF initiating warfarin that was not explained by differences in risk factors or achieved anticoagulation quality.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Baumgartner

Fan

Fang

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…Although not routinely assessed in clinical visits, geriatric impairments, such as frailty and cognitive impairment, are associated with OAC success and outcomes. For example, cognitive impairment, lack of social support, and frailty are associated with poor adherence to OAC and lower time in therapeutic range (TTR), whereas depression is associated with low TTR and more frequent dose adjustments for patients taking warfarin …”

mentioning

confidence: 99%

Geriatric Elements and Oral Anticoagulant Prescribing in Older Atrial Fibrillation Patients: SAGE‐AF

Saczynski

Sanghai

Kiefe

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

OBJECTIVES Oral anticoagulants are the cornerstone of stroke prevention in high‐risk patients with atrial fibrillation (AF). Geriatric elements, such as cognitive impairment and frailty, commonly occur in these patients and are often cited as reasons for not prescribing oral anticoagulants. We sought to systematically assess geriatric impairments in patients with AF and determine whether they were associated with oral anticoagulant prescribing. DESIGN Cross‐sectional analysis of baseline data from the ongoing Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE‐AF) prospective cohort study. SETTING Multicenter study with site locations in Massachusetts and Georgia that recruited participants from cardiology, electrophysiology, and primary care clinics from 2016 to 2018. PARTICIPANTS Participants with AF age 65 years or older, CHA2DS2‐VASc (congestive heart failure; hypertension; aged ≥75 y [doubled]; diabetes mellitus; prior stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65‐74; female sex) score of 2 or higher, and no oral anticoagulant contraindications (n = 1244). MEASUREMENTS A six‐component geriatric assessment included validated measures of frailty, cognitive function, social support, depressive symptoms, vision, and hearing. Oral anticoagulant use was abstracted from the medical record. RESULTS A total of 1244 participants (mean age = 76 y; 49% female; 85% white) were enrolled; 42% were cognitively impaired, 14% frail, 53% pre‐frail, 12% socially isolated, and 29% had depressive symptoms. Oral anticoagulants were prescribed to 86% of the cohort. Oral anticoagulant prescribing did not vary according to any of the geriatric elements (adjusted odds ratios [ORs] for oral anticoagulant prescribing and cognitive impairment: OR = .75; 95% confidence interval [CI] = .51‐1.09; frail OR = .69; 95% CI = .35‐1.36; social isolation OR = .90; 95% CI = .52‐1.54; depression OR = .79; 95% CI = .49‐1.27; visual impairment OR = .98; 95% CI = .65‐1.48; and hearing impairment OR = 1.05; 95% CI = .71‐1.54). CONCLUSION Geriatric impairments, particularly cognitive impairment and frailty, were common in our cohort, but treatment with oral anticoagulants did not differ by impairment status. These geriatric impairments are commonly cited as reasons for not prescribing oral anticoagulants, suggesting that prescribers may either be unaware or deliberately ignoring the presence of these factors in clinical settings. J Am Geriatr Soc 68:147–154, 2019

show abstract

“…From a total of 3692 studies, we selected 16 articles (Figure summarizes the search and selection process). Among them, 11 articles investigated patients taking VKA for nonvalvular AF, 4 for mixed indications and 2 for VTE . Based on these selected articles, we identified 8 positive and 42 negative predictors (Table ).…”

Section: Resultsmentioning

confidence: 99%

Prediction Score for Anticoagulation Control Quality Among Older Adults

Lin

Singer

Glynn

et al. 2017

JAHA

View full text Add to dashboard Cite

BackgroundTime in the therapeutic range (TTR) is associated with the effectiveness and safety of vitamin K antagonist (VKA) therapy. To optimize prescribing of VKA, we aimed to develop and validate a prediction model for TTR in older adults taking VKA for nonvalvular atrial fibrillation and venous thromboembolism.Methods and ResultsThe study cohort comprised patients aged ≥65 years who were taking VKA for atrial fibrillation or venous thromboembolism and who were identified in the 2 US electronic health record databases linked with Medicare claims data from 2007 through 2014. With the predictors identified from a systematic review and clinical knowledge, we built a prediction model for TTR, using one electronic health record system as the training set and the other as the validation set. We compared the performance of the new models to that of a published prediction score for TTR, SAMe‐TT 2R2. Based on 1663 patients in the training set and 1181 in the validation set, our optimized score included 42 variables and the simplified model included 7 variables, abbreviated as PROSPER (Pneumonia, Renal dysfunction, Oozing blood [prior bleeding], Staying in hospital ≥7 days, Pain medication use, no Enhanced [structured] anticoagulation services, Rx for antibiotics). The PROSPER score outperformed SAMe‐TT 2R2 when predicting both TTR ≥70% (area under the receiver operating characteristic curve 0.67 versus 0.55) and the thromboembolic and bleeding outcomes (area under the receiver operating characteristic curve 0.62 versus 0.52).ConclusionsOur geriatric TTR score can be used as a clinical decision aid to select appropriate candidates to receive VKA therapy and as a research tool to address confounding and treatment effect heterogeneity by anticoagulation quality.

show abstract

Outcomes of Anticoagulation Therapy in Patients with Mental Health Conditions

Cited by 32 publications

References 29 publications

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

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

Geriatric Elements and Oral Anticoagulant Prescribing in Older Atrial Fibrillation Patients: SAGE‐AF

Prediction Score for Anticoagulation Control Quality Among Older Adults

Contact Info

Product

Resources

About