Mental health conditions and adherence to direct oral anticoagulants in patients with incident atrial fibrillation: A nationwide cohort study

Konsta Teppo; Jussi Jaakkola; K. E.Juhani Airaksinen; Fausto Biancari; Olli Halminen; Jukka Putaala; Pirjo Mustonen; Jari Haukka; Juha Hartikainen; Alex Luojus; Mikko Niemi; Miika Linna; Mika Lehto

doi:10.1016/j.genhosppsych.2021.12.012

Mental health conditions and adherence to direct oral anticoagulants in patients with incident atrial fibrillation: A nationwide cohort study

Konsta Teppo^*
, Jussi Jaakkola
, K. E.Juhani Airaksinen
, Fausto Biancari
, Olli Halminen
, Jukka Putaala
, Pirjo Mustonen
, Jari Haukka
, Juha Hartikainen
, Alex Luojus
, Mikko Niemi
, Miika Linna
, Mika Lehto

^*Corresponding author for this work

Department of Industrial Engineering and Management

Research output: Contribution to journal › Article › Scientific › peer-review

15 Citations (Scopus)

67 Downloads (Pure)

Abstract

Objective: Medication adherence is essential for effective stroke prevention in patients with atrial fibrillation (AF). We aimed to assess whether adherence to direct oral anticoagulants (DOACs) in AF patients is affected by the presence of mental health conditions (MHCs). Methods: The nationwide FinACAF cohort covered 74,222 AF patients from all levels of care receiving DOACs during 2011–2018 in Finland. Medication possession ratio (MPR) was used to quantify adherence. Patients with MPR ≥0.90 were defined adherent. MHCs of interest were depression, bipolar disorder, anxiety disorder and schizophrenia. Results: The patients' (mean age 75.4 ± 9.5 years, 50.8% female) mean MPR was 0.84 (SD 0.22), and 59.5% had MPR ≥0.90. Compared to patients without MHC, the adjusted ORs (95% CI) for adherent DOAC use emerged slightly lower in patients with depression (0.92 (0.84–0.99)) and bipolar disorder (0.77 (0.61–0.97)) and unsignificant in patients with anxiety disorder (1.08 (0.96–1.21)) and schizophrenia (1.13 (0.90–1.43)). However, when only persistent DOAC therapy was analyzed, no MHC was associated with poor adherence, and instead anxiety disorder was associated with adherent DOAC use (1.18 (1.04–1.34)). Conclusion: Adherence to DOACs in AF patients in Finland was relatively high, and no meaningful differences between patients with and without MHCs were observed.

Original language	English
Pages (from-to)	88-93
Number of pages	6
Journal	General Hospital Psychiatry
Volume	74
DOIs	https://doi.org/10.1016/j.genhosppsych.2021.12.012
Publication status	Published - 1 Jan 2022
MoE publication type	A1 Journal article-refereed

Funding

This work was supported by the Aarne Koskelo Foundation , The Finnish Foundation for Cardiovascular Research , and Helsinki and Uusimaa Hospital District research fund. Konsta Teppo: none. Jussi Jaakkola: none. Fausto Biancari: none Olli Halminen: none. Jukka Putaala: Dr. Putaala reports personal fees from Boehringer-Ingelheim, personal fees and other from Bayer, grants and personal fees from BMS-Pfizer, personal fees from Portola, other from Amgen, personal fees from Herantis Pharma, personal fees from Terve Media, other from Vital Signum, personal fees from Abbott, outside the submitted work. Pirjo Mustonen: Consultant: Roche, BMS-Pfizer-alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. Jari Haukka: Consultant: Research Janssen R&D; Speaker: Bayer Finland. Miika Linna: Speaker: BMSPfizer-alliance, Bayer, Boehringer-Ingelheim. Alex Luojus: none. Juha Hartikainen: Research grants: The Finnish Foundation for Cardiovascular Research, EU Horizon 2020, EU FP7. Advisory Board Member: BMS-Pfizer-alliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. K.E. Juhani Airaksinen: Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer-Ingelheim. Member in the advisory boards: Bayer, Pfizer and AstraZeneca. Mika Lehto: Consultant: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, and MSD; Speaker: BMS-Pfizer-alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer-Ingelheim. Mikko Niemi: None.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Adherence
Atrial fibrillation
Depression
Direct oral anticoagulant
Implementation
Mental health condition
Psychiatric disorder

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10.1016/j.genhosppsych.2021.12.012

Mental health conditions and adherence to direct oral anticoagulants in patients with incident atrial fibrillationFinal published version, 359 KBLicence: CC BY

Cite this

Teppo, K., Jaakkola, J., Airaksinen, K. E. J., Biancari, F., Halminen, O., Putaala, J., Mustonen, P., Haukka, J., Hartikainen, J., Luojus, A., Niemi, M., Linna, M., & Lehto, M. (2022). Mental health conditions and adherence to direct oral anticoagulants in patients with incident atrial fibrillation: A nationwide cohort study. General Hospital Psychiatry, 74, 88-93. https://doi.org/10.1016/j.genhosppsych.2021.12.012

@article{12560096cabb407e8ef10ea16426d476,

title = "Mental health conditions and adherence to direct oral anticoagulants in patients with incident atrial fibrillation: A nationwide cohort study",

abstract = "Objective: Medication adherence is essential for effective stroke prevention in patients with atrial fibrillation (AF). We aimed to assess whether adherence to direct oral anticoagulants (DOACs) in AF patients is affected by the presence of mental health conditions (MHCs). Methods: The nationwide FinACAF cohort covered 74,222 AF patients from all levels of care receiving DOACs during 2011–2018 in Finland. Medication possession ratio (MPR) was used to quantify adherence. Patients with MPR ≥0.90 were defined adherent. MHCs of interest were depression, bipolar disorder, anxiety disorder and schizophrenia. Results: The patients' (mean age 75.4 ± 9.5 years, 50.8\% female) mean MPR was 0.84 (SD 0.22), and 59.5\% had MPR ≥0.90. Compared to patients without MHC, the adjusted ORs (95\% CI) for adherent DOAC use emerged slightly lower in patients with depression (0.92 (0.84–0.99)) and bipolar disorder (0.77 (0.61–0.97)) and unsignificant in patients with anxiety disorder (1.08 (0.96–1.21)) and schizophrenia (1.13 (0.90–1.43)). However, when only persistent DOAC therapy was analyzed, no MHC was associated with poor adherence, and instead anxiety disorder was associated with adherent DOAC use (1.18 (1.04–1.34)). Conclusion: Adherence to DOACs in AF patients in Finland was relatively high, and no meaningful differences between patients with and without MHCs were observed.",

keywords = "Adherence, Atrial fibrillation, Depression, Direct oral anticoagulant, Implementation, Mental health condition, Psychiatric disorder",

author = "Konsta Teppo and Jussi Jaakkola and Airaksinen, \{K. E.Juhani\} and Fausto Biancari and Olli Halminen and Jukka Putaala and Pirjo Mustonen and Jari Haukka and Juha Hartikainen and Alex Luojus and Mikko Niemi and Miika Linna and Mika Lehto",

note = "Funding Information: This work was supported by the Aarne Koskelo Foundation , The Finnish Foundation for Cardiovascular Research , and Helsinki and Uusimaa Hospital District research fund. Funding Information: Konsta Teppo: none. Jussi Jaakkola: none. Fausto Biancari: none Olli Halminen: none. Jukka Putaala: Dr. Putaala reports personal fees from Boehringer-Ingelheim, personal fees and other from Bayer, grants and personal fees from BMS-Pfizer, personal fees from Portola, other from Amgen, personal fees from Herantis Pharma, personal fees from Terve Media, other from Vital Signum, personal fees from Abbott, outside the submitted work. Pirjo Mustonen: Consultant: Roche, BMS-Pfizer-alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. Jari Haukka: Consultant: Research Janssen R\&D; Speaker: Bayer Finland. Miika Linna: Speaker: BMSPfizer-alliance, Bayer, Boehringer-Ingelheim. Alex Luojus: none. Juha Hartikainen: Research grants: The Finnish Foundation for Cardiovascular Research, EU Horizon 2020, EU FP7. Advisory Board Member: BMS-Pfizer-alliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. K.E. Juhani Airaksinen: Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer-Ingelheim. Member in the advisory boards: Bayer, Pfizer and AstraZeneca. Mika Lehto: Consultant: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, and MSD; Speaker: BMS-Pfizer-alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer-Ingelheim. Mikko Niemi: None. Publisher Copyright: {\textcopyright} 2022 The Author(s)",

year = "2022",

month = jan,

day = "1",

doi = "10.1016/j.genhosppsych.2021.12.012",

language = "English",

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Teppo, K, Jaakkola, J, Airaksinen, KEJ, Biancari, F, Halminen, O, Putaala, J, Mustonen, P, Haukka, J, Hartikainen, J, Luojus, A, Niemi, M, Linna, M & Lehto, M 2022, 'Mental health conditions and adherence to direct oral anticoagulants in patients with incident atrial fibrillation: A nationwide cohort study', General Hospital Psychiatry, vol. 74, pp. 88-93. https://doi.org/10.1016/j.genhosppsych.2021.12.012

TY - JOUR

T1 - Mental health conditions and adherence to direct oral anticoagulants in patients with incident atrial fibrillation

T2 - A nationwide cohort study

AU - Teppo, Konsta

AU - Jaakkola, Jussi

AU - Airaksinen, K. E.Juhani

AU - Biancari, Fausto

AU - Halminen, Olli

AU - Putaala, Jukka

AU - Mustonen, Pirjo

AU - Haukka, Jari

AU - Hartikainen, Juha

AU - Luojus, Alex

AU - Niemi, Mikko

AU - Linna, Miika

AU - Lehto, Mika

N1 - Funding Information: This work was supported by the Aarne Koskelo Foundation , The Finnish Foundation for Cardiovascular Research , and Helsinki and Uusimaa Hospital District research fund. Funding Information: Konsta Teppo: none. Jussi Jaakkola: none. Fausto Biancari: none Olli Halminen: none. Jukka Putaala: Dr. Putaala reports personal fees from Boehringer-Ingelheim, personal fees and other from Bayer, grants and personal fees from BMS-Pfizer, personal fees from Portola, other from Amgen, personal fees from Herantis Pharma, personal fees from Terve Media, other from Vital Signum, personal fees from Abbott, outside the submitted work. Pirjo Mustonen: Consultant: Roche, BMS-Pfizer-alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. Jari Haukka: Consultant: Research Janssen R&D; Speaker: Bayer Finland. Miika Linna: Speaker: BMSPfizer-alliance, Bayer, Boehringer-Ingelheim. Alex Luojus: none. Juha Hartikainen: Research grants: The Finnish Foundation for Cardiovascular Research, EU Horizon 2020, EU FP7. Advisory Board Member: BMS-Pfizer-alliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. K.E. Juhani Airaksinen: Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer-Ingelheim. Member in the advisory boards: Bayer, Pfizer and AstraZeneca. Mika Lehto: Consultant: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, and MSD; Speaker: BMS-Pfizer-alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer-Ingelheim. Mikko Niemi: None. Publisher Copyright: © 2022 The Author(s)

PY - 2022/1/1

Y1 - 2022/1/1

N2 - Objective: Medication adherence is essential for effective stroke prevention in patients with atrial fibrillation (AF). We aimed to assess whether adherence to direct oral anticoagulants (DOACs) in AF patients is affected by the presence of mental health conditions (MHCs). Methods: The nationwide FinACAF cohort covered 74,222 AF patients from all levels of care receiving DOACs during 2011–2018 in Finland. Medication possession ratio (MPR) was used to quantify adherence. Patients with MPR ≥0.90 were defined adherent. MHCs of interest were depression, bipolar disorder, anxiety disorder and schizophrenia. Results: The patients' (mean age 75.4 ± 9.5 years, 50.8% female) mean MPR was 0.84 (SD 0.22), and 59.5% had MPR ≥0.90. Compared to patients without MHC, the adjusted ORs (95% CI) for adherent DOAC use emerged slightly lower in patients with depression (0.92 (0.84–0.99)) and bipolar disorder (0.77 (0.61–0.97)) and unsignificant in patients with anxiety disorder (1.08 (0.96–1.21)) and schizophrenia (1.13 (0.90–1.43)). However, when only persistent DOAC therapy was analyzed, no MHC was associated with poor adherence, and instead anxiety disorder was associated with adherent DOAC use (1.18 (1.04–1.34)). Conclusion: Adherence to DOACs in AF patients in Finland was relatively high, and no meaningful differences between patients with and without MHCs were observed.

AB - Objective: Medication adherence is essential for effective stroke prevention in patients with atrial fibrillation (AF). We aimed to assess whether adherence to direct oral anticoagulants (DOACs) in AF patients is affected by the presence of mental health conditions (MHCs). Methods: The nationwide FinACAF cohort covered 74,222 AF patients from all levels of care receiving DOACs during 2011–2018 in Finland. Medication possession ratio (MPR) was used to quantify adherence. Patients with MPR ≥0.90 were defined adherent. MHCs of interest were depression, bipolar disorder, anxiety disorder and schizophrenia. Results: The patients' (mean age 75.4 ± 9.5 years, 50.8% female) mean MPR was 0.84 (SD 0.22), and 59.5% had MPR ≥0.90. Compared to patients without MHC, the adjusted ORs (95% CI) for adherent DOAC use emerged slightly lower in patients with depression (0.92 (0.84–0.99)) and bipolar disorder (0.77 (0.61–0.97)) and unsignificant in patients with anxiety disorder (1.08 (0.96–1.21)) and schizophrenia (1.13 (0.90–1.43)). However, when only persistent DOAC therapy was analyzed, no MHC was associated with poor adherence, and instead anxiety disorder was associated with adherent DOAC use (1.18 (1.04–1.34)). Conclusion: Adherence to DOACs in AF patients in Finland was relatively high, and no meaningful differences between patients with and without MHCs were observed.

KW - Adherence

KW - Atrial fibrillation

KW - Depression

KW - Direct oral anticoagulant

KW - Implementation

KW - Mental health condition

KW - Psychiatric disorder

UR - https://www.scopus.com/pages/publications/85122261477

U2 - 10.1016/j.genhosppsych.2021.12.012

DO - 10.1016/j.genhosppsych.2021.12.012

M3 - Article

AN - SCOPUS:85122261477

SN - 0163-8343

VL - 74

SP - 88

EP - 93

JO - General Hospital Psychiatry

JF - General Hospital Psychiatry

ER -

Mental health conditions and adherence to direct oral anticoagulants in patients with incident atrial fibrillation: A nationwide cohort study

Abstract

Funding

UN SDGs

Keywords

Access to Document

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