BACKGROUND
Depression is common in atrial fibrillation (AF) and related to adverse prognosis. Early rhythm control (ERC) has been shown to improve cardiovascular outcomes in AF; however, its impact on depression, remains less understood.
OBJECTIVE
To investigate the association between ERC and the risk of depression onset or worsening.
METHOD
We analyzed 533,328 AF patients from the National Health Information Database, categorized by prior depression (Group A: without; Group B: with). According to the ERC status (the initiation of rhythm control within one year of AF diagnosis), we evaluated new-onset depression in Group A and hospital admission for depression-related/any psychiatric condition in Group B.
RESULT
Of the total, 349,804 (65.6%) were Group A (mean age 62.8 years; male 63.8%), and 183,524 (34.4%) were Group B (mean age 65.6 years; male 45.8%). The proportion of patients receiving ERC was 30.1% in Group A and 27.7% in Group B. In Group A, ERC was associated with a lower risk of new-onset depression: adjusted HR (aHR) with 95% confidence interval (CI)=0.963 (0.946-0.980), p<0.001. In Group B, ERC was associated with a lower risk of hospital admission for depression as a principal diagnostic code [aHR (95% CI)=0.714 (0.619-0.822), p<0.001], depression listed among the top-five diagnostic codes [aHR (95% CI)=0.812 (0.777-0.848), p<0.001], and any psychiatric condition [aHR (95% CI)=0.652 (0.605-0.703), p<0.001] than usual care group. The lower risk of hospital admission for depression associated with ERC was more pronounced among younger (<65 years) and male AF patients.
CONCLUSION
ERC is associated with a lower risk of depression onset or worsening in patients with AF.
H. Ahn, So-Ryoung Lee, Bongseong Kim et al.· Heart Rhythm· 0 citations
BACKGROUND
The benefit of combining early rhythm control (ERC) and exercise habit change in atrial fibrillation (AF) is unknown.
OBJECTIVE
To evaluate the primary outcomes - major adverse cardiovascular event (MACE) and all-cause death - according to the combination of ERC status and exercise habit change.
METHOD
From the National Health Information Database, we included 161,379 patients diagnosed with AF. Rhythm control initiated within two-year from AF diagnosis was defined as ERC. Based on the status of regular exercise at serial health examinations before and after AF diagnosis, exercise habit change was categorized into persistent non-exercisers, exercise dropouts, new exercisers, and exercise maintainers.
RESULT
During a mean follow-up of 4.6 years, ERC was associated with a lower risk of MACE and all-cause death; adjusted hazard ratio (aHR) and 95% confidence interval (CI) was 0.832 (0.797-0.868) for MACE and 0.953 (0.915-0.992) for all-cause death (both p<0.001). Exercise maintenance was also associated with a lower risk of MACE and all-cause death: adjusted HR (95% CI)=0.822 (0.763-0.886) for MACE and 0.708 (0.658-0.762) for all-cause death (both p<0.001). There was a progressive decrease in the risk of MACE and all-cause death as AF patient engaged in ERC or regular exercise; the combination of ERC and exercise maintenance provided the greatest benefit, associated with the lowest risk of MACE [aHR (95% CI)=0.641 (0.576-0.713)] and all-cause death [aHR (95%CI)=0.564 (0.499-0.636)], both p<0.001.
CONCLUSION
The combination of ERC and exercise maintenance yielded a synergistic effect, maximizing the reduction in MACE and all-cause death risks, highlighting integrated management in AF.
H. Ahn, So-Ryoung Lee, E. Choi et al.· Heart Rhythm· 0 citations
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