Anticoagulation for atrial fibrillation in people with serious mental illness in the general hospital setting

Dina Farran; Daniel Bean; Tao Wang; Yamiko Msosa; Cecilia Casetta; Richard Dobson; James T Teo; Paul Scott; Fiona Gaughran

doi:10.1016/j.jpsychires.2022.06.044

Anticoagulation for atrial fibrillation in people with serious mental illness in the general hospital setting

J Psychiatr Res. 2022 Sep:153:167-173. doi: 10.1016/j.jpsychires.2022.06.044. Epub 2022 Jun 28.

Authors

Dina Farran¹, Daniel Bean², Tao Wang³, Yamiko Msosa³, Cecilia Casetta⁴, Richard Dobson⁵, James T Teo⁶, Paul Scott⁷, Fiona Gaughran⁸

Affiliations

¹ Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Electronic address: dina.1.farran@kcl.ac.uk.
² Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Health Data Research UK London, Institute of Health Informatics, University College London, London, UK.
³ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁴ Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Health Sciences, ASST Santi Paolo Carlo, Milano, Italy.
⁵ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Health Data Research UK London, Institute of Health Informatics, University College London, London, UK; NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
⁶ Department of Neurosciences, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
⁷ Department of Cardiology, King's College Hospital, Denmark Hill, London, UK.
⁸ Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.

PMID: 35816976
DOI: 10.1016/j.jpsychires.2022.06.044

Abstract

Objective: People with serious mental illnesses (SMI) have an increased risk of stroke compared to the general population. This study aims to evaluate oral anticoagulation prescription trends in atrial fibrillation (AF) patients with and without a comorbid SMI.

Methods: An open-source retrieval system for clinical data (CogStack) was used to identify a cohort of AF patients with SMI who ever had an inpatient admission to King's College Hospital from 2011 to 2020. A Natural Language Processing pipeline was used to calculate CHA2DS2-VASc and HASBLED risk scores from Electronic Health Records free text. Antithrombotic prescriptions of warfarin and Direct acting oral anti-coagulants (DOACs) (apixaban, rivaroxaban, dabigatran, edoxaban) were extracted from discharge summaries.

Results: Among patients included in the study (n = 16 916), 2.7% had a recorded co-morbid SMI diagnosis. Compared to non-SMI patients, those with SMI had significantly higher CHA2DS2-VASc (mean (SD): 5.3 (1.96) vs 4.7 (2.08), p < 0.001) and HASBLED scores (mean (SD): 3.2 (1.27) vs 2.5 (1.29), p < 0.001). Among AF patients having a CHA2DS2-VASc ≥2, those with co-morbid SMI were less likely than non-SMI patients to be prescribed an OAC (44% vs 54%, p < 0.001). However, there was no evidence of a significant difference between the two groups since 2019.

Conclusion: Over recent years, DOAC prescription rates have increased among AF patients with SMI in acute hospitals. More research is needed to confirm whether the introduction of DOACs has reduced OAC treatment gaps in people with serious mental illness and to assess whether the use of DOACs has improved health outcomes in this population.

Keywords: Atrial fibrillation; DOACs; Oral anticoagulation; Serious mental illness; Warfarin.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Administration, Oral
Anticoagulants / therapeutic use
Atrial Fibrillation* / complications
Atrial Fibrillation* / drug therapy
Atrial Fibrillation* / epidemiology
Hospitals, General
Humans
Mental Disorders* / drug therapy
Mental Disorders* / epidemiology
Retrospective Studies
Stroke* / epidemiology

Substances

Anticoagulants

Abstract

Publication types

MeSH terms

Substances

Grants and funding