Per Wändell1,2, Axel C Carlsson1,2,3, Danijela Gasevic4, Lars Wahlström5, Jan Sundquist6,7, Kristina Sundquist6,7. 1. a Division of Family Medicine, Department of Neurobiology , Care Sciences and Society (NVS), Karolinska Institutet , Huddinge , Sweden ; 2. b Academic Primary Care Centre, Stockholm County Council , Huddinge , Sweden ; 3. c Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory , Uppsala University , Uppsala , Sweden ; 4. d Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh , Edinburgh , UK ; 5. e Centre for Psychiatry Research, Karolinska Institutet , Stockholm , Sweden ; 6. f Center for Primary Health Care Research, Lund University , Malmö , Sweden ; 7. g Stanford Prevention Research Center, Stanford University School of Medicine , Palo Alto , California , USA.
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.
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 AFpatients. 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.
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