Mental illness and warfarin use in atrial fibrillation.

Walker GA, Heidenreich PA, Phibbs CS, Go AS, Chiu VY, Schmitt SK, Ananth L, Frayne SM. Mental illness and warfarin use in atrial fibrillation. The American journal of managed care. 2011 Sep 1; 17(9):617-24.

Related HSR&D Project(s)

• IIR 04-248 – Stroke Prevention in Atrial Fibrillation: Impact of Mental Illness
• SDP 09-160 – Implementation of the Hospital to Home (H2H) Heart failure Initiative

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Abstract:

OBJECTIVES: To determine whether atrial fibrillation (AF) patients with mental health conditions (MHCs) were less likely than AF patients without MHCs to be prescribed warfarin and, if receiving warfarin, to maintain an International Normalized Ratio (INR) within the therapeutic range. STUDY DESIGN: Detailed chart review of AF patients using a Veterans Health Administration (VHA) facility in 2003. METHODS: For a random sample of 296 AF patients, records identified clinician-diagnosed MHCs (independent variable) and AF-related care in 2003 (dependent variables), receipt of warfarin, INR values below/above key thresholds, and time spent within the therapeutic range (2.0-3.0) or highly out of range. Differences between the MHC and comparison groups were examined using X2 tests and logistic regression controlling for age and comorbidity. RESULTS: Among warfarin-eligible AF patients (n = 246), 48.5% of those with MHCs versus 28.9% of those without MHCs were not treated with warfarin (P = .004). Among those receiving warfarin and monitored in VHA, highly supratherapeutic INRs were more common in the MHC group; for example, 27.3% versus 1.6% had any INR > 5.0 (P < .001). Differences persisted after adjusting for age and comorbidity. CONCLUSIONS: MHC patients with AF were less likely than those without MHC to have adequate management of their AF care. Interventions directed at AF patients with MHC may help to optimize their outcomes.