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

BACKGROUND: Anxiety 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...

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Autores principales: 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.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6015441/
https://www.ncbi.nlm.nih.gov/pubmed/29656278
http://dx.doi.org/10.1161/JAHA.117.007814
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author 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.
author_facet 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.
author_sort Baumgartner, Christine
collection PubMed
description BACKGROUND: Anxiety 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 RESULTS: The 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. CONCLUSIONS: Diagnosed 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.
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spelling pubmed-60154412018-07-05 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. J Am Heart Assoc Original Research BACKGROUND: Anxiety 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 RESULTS: The 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. CONCLUSIONS: Diagnosed 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. John Wiley and Sons Inc. 2018-04-14 /pmc/articles/PMC6015441/ /pubmed/29656278 http://dx.doi.org/10.1161/JAHA.117.007814 Text en © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
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.
Anxiety, Depression, and Adverse Clinical Outcomes in Patients With Atrial Fibrillation Starting Warfarin: Cardiovascular Research Network WAVE Study
title Anxiety, Depression, and Adverse Clinical Outcomes in Patients With Atrial Fibrillation Starting Warfarin: Cardiovascular Research Network WAVE Study
title_full Anxiety, Depression, and Adverse Clinical Outcomes in Patients With Atrial Fibrillation Starting Warfarin: Cardiovascular Research Network WAVE Study
title_fullStr Anxiety, Depression, and Adverse Clinical Outcomes in Patients With Atrial Fibrillation Starting Warfarin: Cardiovascular Research Network WAVE Study
title_full_unstemmed Anxiety, Depression, and Adverse Clinical Outcomes in Patients With Atrial Fibrillation Starting Warfarin: Cardiovascular Research Network WAVE Study
title_short Anxiety, Depression, and Adverse Clinical Outcomes in Patients With Atrial Fibrillation Starting Warfarin: Cardiovascular Research Network WAVE Study
title_sort anxiety, depression, and adverse clinical outcomes in patients with atrial fibrillation starting warfarin: cardiovascular research network wave study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6015441/
https://www.ncbi.nlm.nih.gov/pubmed/29656278
http://dx.doi.org/10.1161/JAHA.117.007814
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