University of Oulu

Jussi Jaakkola and others, The effect of mental health conditions on the use of oral anticoagulation therapy in patients with atrial fibrillation: the FinACAF study, European Heart Journal - Quality of Care and Clinical Outcomes, Volume 8, Issue 3, May 2022, Pages 269–276,

The effect of mental health conditions on the use of oral anticoagulation therapy in patients with atrial fibrillation : the FinACAF study

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Author: Jaakkola, Jussi1,2; Teppo, Konsta1; Biancari, Fausto3,4,5;
Organizations: 1Heart Center, Turku University Hospital, and University of Turku, Hämeentie 11, Turku, Finland
2Heart Unit, Satakunta Central Hospital, Sairaalantie 3, FI-28500 Pori, Finland
3Heart and Lung Center, Helsinki University Hospital, and University of Helsinki, Haartmaninkatu 4, Helsinki, Finland
4Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Kajaanintie 50, Oulu, Finland
5Clinica Montevergine, GVM Care & Research, Via Mario Malzoni 5, Mercogliano, Italy
6Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
7Department of Neurology, Helsinki University Hospital, and University of Helsinki, Haartmaninkatu 4, Helsinki, Finland
8Department of Population Health, University of Helsinki, Yliopistonkatu 4, Helsinki, Finland
9Department of Health and Social Management, University of Eastern Finland, Yliopistonranta 1, Kuopio, Finland
10Heart Center, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio, Finland
11Department of Internal Medicine, Lohja Hospital, Sairaalatie 8, Lohja, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
Persistent link:
Language: English
Published: Oxford University Press, 2021
Publish Date: 2023-06-01


Aims: Little is known about the effects of mental health conditions (MHCs) on the utilization of oral anticoagulation (OAC) therapy in atrial fibrillation (AF) patients. We aimed to assess whether MHCs affect initiation of OAC therapy among AF patients with special focus on non-vitamin K antagonist oral anticoagulants (NOACs).

Methods and results: The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) registry included all 239 222 patients diagnosed with incident AF during 2007–18 in Finland identified from national registries covering primary to tertiary care and drug purchases. Patients with previous depression, bipolar disorder, anxiety disorder, or schizophrenia diagnosis or a fulfilled psychiatric medication prescription within the year preceding the AF diagnosis were classified to have any MHC. The main outcome was OAC initiation, defined as first fulfilled OAC prescription after AF diagnosis. The patients’ mean age was 72.7 years and 49.8% were female. The prevalence of any MHC was 19.9%. A lower proportion of patients with any MHC compared with those without MHCs were initiated on OAC therapy (64.9% vs. 73.3%, P < 0.001). Any MHC was associated with lower incidence of OAC initiation [adjusted subdistribution hazard ratio (aSHR) 0.867; 95% confidence interval (CI) 0.856–0.880], as were depression (aSHR 0.868; 95% CI 0.856–0.880), bipolar disorder (aSHR 0.838; 95% CI 0.824–0.852), anxiety disorder (aSHR 0.840; 95% CI 0.827–0.854), and schizophrenia (aSHR 0.838; 95% CI 0.824–0.851), during the entire follow-up. Any MHC remained associated with impaired incidence of OAC initiation also in the NOAC era during 2015–18 (aSHR 0.821; 95% CI 0.805–0.837).

Conclusion: MHCs are common among AF patients, and they are associated with a lower rate of OAC initiation even during the NOAC era.

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Series: European heart journal. Quality of care & clinical outcomes
ISSN: 2058-5225
ISSN-E: 2058-1742
ISSN-L: 2058-5225
Volume: 8
Issue: 3
Pages: 269 - 276
DOI: 10.1093/ehjqcco/qcab077
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: Aarne Koskelo Foundation; the Finnish Foundation for Cardiovascular Research; Helsinki and Uusimaa Hospital District research fund (TYH2019309).
Copyright information: © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.