Association of early rhythm control with depression outcomes in atrial fibrillation: A nationwide population-based cohort study.

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.