Farran, D;
Bean, D;
Wang, T;
Msosa, Y;
Casetta, C;
Dobson, R;
Teo, JT;
... Gaughran, F; + view all
(2022)
Anticoagulation for atrial fibrillation in people with serious mental illness in the general hospital setting.
Journal of Psychiatric Research
, 153
pp. 167-173.
10.1016/j.jpsychires.2022.06.044.
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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.
| Type: | Article |
|---|---|
| Title: | Anticoagulation for atrial fibrillation in people with serious mental illness in the general hospital setting |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.jpsychires.2022.06.044 |
| Publisher version: | https://doi.org/10.1016/j.jpsychires.2022.06.044 |
| Language: | English |
| Additional information: | © 2022 The Authors. Published by Elsevier Ltd. under a Creative Commons license (https://creativecommons.org/licenses/by/4.0/). |
| Keywords: | Atrial fibrillation, DOACs, Oral anticoagulation, Serious mental illness, Warfarin |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics > Clinical Epidemiology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10153178 |
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