Early rhythm control and mental health-related hospitalizations in young and middle-aged patients with atrial fibrillation.

BACKGROUND

Atrial fibrillation (AF) is strongly associated with mental health disorders, increasing susceptibility to both AF and conditions such as depression and anxiety.

OBJECTIVE

This study investigated whether early rhythm control (ERC) within 1 year of AF diagnosis reduces mental health-related health care utilization in young and middle-aged individuals with preexisting mental health conditions.

METHODS

Using data from the Korean National Health Insurance Service (2010-2020), we identified 166,797 patients with AF <65 years with a history of depression or anxiety. Patients were classified into an ERC group (rhythm control within 1 year of diagnosis) and a usual care group. The primary outcome was hospitalization with depression or anxiety as the principal diagnosis. Secondary outcomes included hospitalizations where depression or anxiety was among the top 5 diagnoses and psychiatric hospitalizations. Cox regression and propensity score matching were used to assess risks.

RESULTS

A median follow-up duration was of 5.3 years (interquartile range 2.9-9.3). After 1:1 propensity score matching, ERC was associated with a lower risk of primary outcome hospitalization (hazard ratio [HR] 0.795, 95% confidence interval [CI] 0.689-0.916, P = .001). ERC also reduced hospitalizations with depression or anxiety (HR 0.852, 95% CI 0.815-0.890, P < .001) and psychiatric hospitalizations (HR 0.621, 95% CI 0.566-0.681, P < .001). Benefits were consistent across subgroups, with a stronger effect in younger patients.

CONCLUSION

ERC in young and middle-aged patients with AF aged <65 years with preexisting mental health conditions was associated with a lower risk of mental health-related hospitalizations, highlighting the importance of timely rhythm control in this population.