ArticleBMJ open2017
Atrial fibrillation in patients with severe mental disorders and the risk of stroke, fatal thromboembolic events and bleeding: a nationwide cohort study.
Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- Bipolar disorder and the risk for stroke incidence and mortality: a meta-analysis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2022Pooled it
- Mental Health Conditions and Nonpersistence of Direct Oral Anticoagulant Use in Patients With Incident Atrial Fibrillation: A Nationwide Cohort Study.Journal of the American Heart Association · 2022Trial
- Association between depression and risk of ischaemic stroke in patients with atrial fibrillation.European heart journal open · 2026Article
- Clustering of electronic health records in atrial fibrillation patients and impact on prognosis and patient trajectories: a UK linked-dataset study.European heart journal. Digital health · 2025Article
- Persistent Mental Health-Related Disparities in Stroke Prevention for Atrial Fibrillation in the Era of Direct Oral Anticoagulants.CJC open · 2025Article
- Do patients with bipolar disorders have an increased risk of stroke? A systematic review and meta-analysis.Pakistan journal of medical sciences · 2024Article
- Pathophysiological Mechanisms of Psychosis-Induced Atrial Fibrillation: The Links between Mental Disorder and Arrhythmia.Reviews in cardiovascular medicine · 2024Review
- Atrial fibrillation: comorbidities, lifestyle, and patient factors.The Lancet regional health. Europe · 2024Review
- Exploring the Association between Schizophrenia and Cardiovascular Diseases: Insights into the Role of Sigma 1 Receptor.Physiological research · 2023Review
- Mental health conditions and risk of first-ever ischaemic stroke and death in patients with incident atrial fibrillation: A nationwide cohort study.European journal of clinical investigation · 2022Article
- Disparities in oral anticoagulation initiation in patients with schizophrenia and atrial fibrillation: A nationwide cohort study.British journal of clinical pharmacology · 2022Article
- Mortality in people with schizophrenia: a systematic review and meta-analysis of relative risk and aggravating or attenuating factors.World psychiatry : official journal of the World Psychiatric Association (WPA) · 2022Article
- 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 & clinical outcomes · 2022Article
- The impact of mental health conditions on oral anticoagulation therapy and outcomes in patients with atrial fibrillation: A systematic review and meta-analysis.American journal of preventive cardiology · 2021Article
- Association Between Bipolar Disorder or Schizophrenia and Oral Anticoagulation Use in Danish Adults With Incident or Prevalent Atrial Fibrillation.JAMA network open · 2021Article
- Evaluation of Warfarin Use in Patients With Mental Health Conditions in a Rural Community Health Center System.The Journal of pharmacy technology : jPT : official publication of the Association of Pharmacy Technicians · 2021Article
- Depressive symptoms and cardiovascular disease: a population-based study of older adults in rural Burkina Faso.BMJ open · 2020Article
- Impact of psychiatric comorbidity on the severity, short-term functional outcome, and psychiatric complications after acute stroke.Neuropsychiatric disease and treatment · 2019Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesOutcomes of atrial fibrillation (AF) in patients with severe mental disorders are largely unknown. We compared rates of stroke, fatal thromboembolic events and bleeding in patients with AF with and without mental disorders.
designNationwide registry-based cohort study.
settingDenmark (population 5.6 million), 2000-2015.
participantsPatients with AF with schizophrenia (n=534), severe depression (n=400) or bipolar disease (n=569) matched 1:5 on age, sex and calendar time to patients with AF without mental disorders. EXPOSURE: Inpatient or hospital-based outpatient diagnosis of schizophrenia, severe depression or bipolar disease. PRIMARY AND SECONDARY OUTCOME MEASURES: HRs for stroke, fatal thromboembolic events and major bleeding comparing patients with and without mental disorders estimated by Cox regression with sequential adjustment for risk factors for stroke and bleeding, comorbidity and initiation of oral anticoagulant therapy (OAT).
resultsCompared with matched comparisons, crude 5-year HRs of ischaemic stroke were 1.37 (95% CI 0.88 to 2.14) for schizophrenia, 1.36 (95% CI 0.89 to 2.08) for depression and 1.04 (95% CI 0.69 to 1.56) for bipolar disease. After adjusting for risk factors, comorbidity and OAT, these HRs declined towards the null. Crude HRs of fatal thromboembolic events were 3.16 (95% CI 1.78 to 5.61) for schizophrenia, 1.31 (95% CI 0.67 to 2.56) for depression and 1.53 (95% CI 0.93 to 2.53) for bipolar disease. Rates of major bleeding were increased in patients with schizophrenia (crude HR 1.37, 95% CI 0.99 to 1.90) and severe depression (HR 1.25, 95% CI 0.87 to 1.78) but not bipolar disease (HR 0.82, 95% CI 0.58 to 1.15).
conclusionPatients with AF with schizophrenia or severe depression experienced increased rates of stroke and major bleeding compared with matched comparisons. This increase was largely explained by differences in the prevalence of risk factors for stroke and bleeding, comorbidity and initiation of OAT during follow-up. Patients with AF with schizophrenia further experienced higher mortality following thromboembolic events than matched comparisons without mental disorders.
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