While post-AF MDD has been extensively studied, contemporary studies including temporal trends on impact of pre-AF MDD on AF and post-AF outcomes are lacking. So, a study was conducted by Mansuri et al. to determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing major depressive disorder (MDD). The investigators used Nationwide Inpatient Sample from 2002 to 2012. They identified AF and MDD as primary and secondary diagnosis respectively using validated ICD-9-CM codes, and used Cochrane-Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).
A total of 3,887,827 AF hospital admissions were analyzed from 2002 to 2012 of which 6.78% had MDD. Proportion of hospitalizations with MDD increased from 4.93% to 14.19% (P-trend < 0.001). Utilization of atrial cardioversion was lower in patients with MDD (34.37% vs. 40.52%, P < 0.001). In-hospital mortality was significantly lower in patients with MDD (aOR0.749; 95% CI 0.664–0.846; P < 0.001) but discharge to specialty care was higher (aOR 1.695; 95%CI 1.650–1.741; P < 0.001). In addition, median length of hospitalization (2.5 vs. 2.13 days; P < 0.001) and median cost of hospitalization (28,246 vs. 22,663; P < 0.001) was higher in hospitalizations with MDD.
This study displayed an increasing proportion of patients with MDD admitted due to AF in the last decade with lower mortality but higher morbidity post-AF. In addition, there was significantly less utilization of atrial cardioversion in this population along with higher median length and cost of hospitalization. There is a need to explore the reasons behind this disparity in outcomes and atrial cardioversion utilization in order to improve post-AF outcomes in this vulnerable population.
by Dr. Zeeshan Mansuri MD MPH
Psychiatry Resident, Texas Tech University Health Science Center (Midland, TX)