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 patients with AF 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 1 year of AF diagnosis), we evaluated new-onset depression in group A and hospital admission for depression-related or any psychiatric condition in group B.

RESULT: Of the total patients, 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 hazard ratio (aHR) of 0.963 with 95% confidence interval (CI) of 0.946-0.980 (P < .001). In group B, ERC was associated with a lower risk of hospital admission for depression as a principal diagnostic code (aHR = 0.714 [95% CI: 0.619-0.822], P < .001), depression listed among the top 5 diagnostic codes (aHR = 0.812 [95% CI, 0.777-0.848], P < .001), and any psychiatric condition (aHR = 0.652 [95% CI, 0.605-0.703], P < .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 patients with AF.

CONCLUSION

ERC is associated with a lower risk of depression onset or worsening in patients with AF.