Impact of anxiety disorders on adherence to anticoagulant therapy in patients with atrial fibrillation

Cover Page

Cite item

Full Text

Abstract

Aim. To evaluate the impact of anxiety disorders on adherence to anticoagulant therapy (ACT) in patients with atrial fibrillation (AF).

Materials and methods. 179 outpatients (131 women, 48 men, mean age 69.9±6.2 years) with AF were examined. The research methods included a physical examination according to the standards of medical care in an outpatient facility, clinical and psychopathological examination using psychometric scales.

Results. Based on the assessment of adherence to ACT using the Morisky–Green test, 2 groups of patients were identified: Group 1 – patients with high adherence to ACT, Group 2 – patients with partial/low adherence to ACT. In group 1, anxiety disorders were verified in 51.7% of cases, in group 2 – 54.3%. There were no statistically significant differences in the prevalence and severity of anxiety in the study groups. In accordance with the binary logistic regression model, the probability of high adherence to therapy is determined by higher (compared with the group of patients with partial/low adherence to therapy) scores in terms of “mental health” (p<0.001), “vital activity” (p=0.02) and the total score of the SF-36 scale (p=0.08), as well as the extraversion parameter (p=0.02) of the NEO-FFI scale.

Conclusion. In the present study, no significant association was found between anxiety symptoms and a decrease in adherence to ACT in patients with AF. However, the results obtained suggest a contribution to the adherence to therapy of personality characteristics.

About the authors

Anastasia V. Fomicheva

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: nastassja.fomicheva@gmail.com
ORCID iD: 0000-0003-3624-0981

аспирант каф. психиатрии и психосоматики Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Daria V. Troshina

Sechenov First Moscow State Medical University (Sechenov University)

Email: nastassja.fomicheva@gmail.com
ORCID iD: 0000-0002-5046-6699

канд. мед. наук, специалист по научно-методической работе Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Anatoly N. Simonov

Mental Health Research Center

Email: nastassja.fomicheva@gmail.com
ORCID iD: 0000-0003-0564-932X

канд. биол. наук, рук. лаб. доказательной медицины и биостатистики

Russian Federation, Moscow

Philipp Iu. Kopylov

Sechenov First Moscow State Medical University (Sechenov University)

Email: nastassja.fomicheva@gmail.com
ORCID iD: 0000-0001-5124-6383

д-р мед. наук, проф., дир. Института персонализированной кардиологии

Russian Federation, Moscow

Denis A. Andreev

Sechenov First Moscow State Medical University (Sechenov University)

Email: nastassja.fomicheva@gmail.com
ORCID iD: 0000-0002-0276-7374

д-р мед. наук, проф., зав. каф. кардиологии, функциональной и ультразвуковой диагностики Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Beatrice A. Volel

Sechenov First Moscow State Medical University (Sechenov University); Mental Health Research Center

Email: nastassja.fomicheva@gmail.com
ORCID iD: 0000-0003-1667-5355

д-р мед. наук, проф., дир. Института клинической медицины им. Н.В. Склифосовского; ст. науч. сотр.

Russian Federation, Moscow; Moscow

References

  1. Бокерия Л.А., Полунина А.Г., Лефтерова Н.П., и др. Фибрилляция предсердий, дилатация левых камер сердца: пусковые механизмы развития когнитивных нарушений у кардиологических пациентов. Креативная кардиология. 2015;9(1):38-45 [Bockeria LA, Polunina AG, Lefterova NF, et al. Atrium fibrillation and enlargement of left heart chambers: pathological mechanisms of cognitive dysfunction in cardiologic patients. Kreativnaya kardiologiya. 2015;9(1):38-45 (in Russian)]. doi: 10.15275/kreatkard.2015.01.04
  2. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837-47. doi: 10.1161/CIRCULATIONAHA.113.005119
  3. Zoni-Berisso M, Lercari F, Carazza T, et al. Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol. 2014;6:213-20. doi: 10.2147/CLEP.S47385
  4. Staerk L, Sherer JA, Ko D, et al. Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes. Circ Res. 2017;120(9):1501-17. doi: 10.1161/CIRCRESAHA.117.309732
  5. Cramer JA, Roy A, Burrell A, et al. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11(1):44-7. doi: 10.1111/j.1524-4733.2007.00213.x
  6. Mozaffarian D, Benjamin EJ, Go AS, et al. Executive summary: heart disease and stroke statistics – 2016 update: a report from the American Heart Association. Circulation. 2016;133(4):447-54. doi: 10.1161/CIR.0000000000000366
  7. World Health Organisation. Adherence to long-term therapies, evidence for action. Available at: https://www.who.int/chp/knowledge/publications/adherence_report/en/ Acessed: 09.27.2022.
  8. Кобалава Ж.Д., Виллевальде С.В., Троицкая Е.А. Проблема приверженности к антикоагулянтной терапии и пути ее решения. Кардиология. 2016;56(1):71-8 [Kobalava ZhD, Villewalde SV, Troitskaya EA. The Problem of Adherence to Anticoagulant Therapy and Ways to Its Solution. Kardiologiia. 2016;56(1):71-8 (in Russian)]. doi: 10.18565/cardio.2016.1.71-78
  9. Deitelzweig SB, Buysman E, Pinsky B, et al. Warfarin use and stroke risk among patients with nonvalvular atrial fibrillation in a large managed care population. Clin Ther. 2013;35(8):1201-10. doi: 10.1016/j.clinthera.2013.06.005
  10. Недоступ А.В., Соловьева А.Д., Санькова Т.А. Психовегетативные соотношения у больных с пароксизмальной формой мерцательной аритмии. Терапевтический архив. 2001;76(9):55-61 [Nedostup AV, Solov'eva AD, San'kova TA. Psikhovegetativnye sootnosheniia u bol'nykh s paroksizmal'noi formoi mertsatel'noi aritmii. Terapevticheskii Arkhiv (Ter. Arkh.). 2001;76(9):55-61 (in Russian)].
  11. Яковенко Т.В. Нозогенные психические реакции у больных фибрилляцией предсердий: автореф. дисс. … канд. мед. наук. СПб., 2009 [Iakovenko TV. Nozogennye psikhicheskie reaktsii u bol'nykh fibrilliatsiei predserdii: avtoref. diss. … kand. med. nauk. Saint Petersburg, 2009 (in Russian)].
  12. Barsky AJ, Cleary PD, Coeytaux RR, Ruskin JN. Psychiatric disorders in medical outpatients complaining of palpitations. J Gen Intern Med. 1994;9(6):306-13. doi: 10.1007/BF02599176
  13. Patel D, McConkey ND, Sohaney R, et al. A systematic review of depression and anxiety in patients with atrial fibrillation: the mind-heart link. Cardiovasc Psychiatry Neurol. 2013;2013:159850. doi: 10.1155/2013/159850
  14. Søgaard M, Skjøth F, Kjældgaard JN, et al. Atrial fibrillation in patients with severe mental disorders and the risk of stroke, fatal thromboembolic events and bleeding: a nationwide cohort study. BMJ Open. 2017;7(12):e018209. doi: 10.1136/bmjopen-2017-018209
  15. Ferguson C, Inglis SC, Newton PJ, et al. Barriers and enablers to adherence to anticoagulation in heart failure with atrial fibrillation: patient and provider perspectives. J Clin Nurs. 2017;26(23-24):4325-34. doi: 10.1111/jocn.13759
  16. Bostrom JA, Saczynski JS, Hajduk A, et al. Burden of Psychosocial and Cognitive Impairment in Patients With Atrial Fibrillation. Crit Pathw Cardiol. 2017;16(2):71-5. doi: 10.1097/HPC.0000000000000101
  17. Fenger-Grøn M, Vestergaard CH, Ribe AR, et al. Association Between Bipolar Disorder or Schizophrenia and Oral Anticoagulation Use in Danish Adults With Incident or Prevalent Atrial Fibrillation. JAMA Netw Open. 2021;4(5):e2110096. doi: 10.1001/jamanetworkopen.2021.10096
  18. Волель Б.А., Трошина Д.В., Фомичева А.В., и др. Влияние психических расстройств на приверженность терапии у пациентов с фибрилляцией предсердий. Кардиология и сердечно-сосудистая хирургия. 2020;13(6):530-8 [Volel BA, Troshina DV, Fomicheva AV, et al. Impact of mental disorders on adherence to therapy in patients with atrial fibrillation. Kardiologiya I Serdechno-Sosudistaya Khirurgiya. 2020;13(6):530-8 (in Russian)]. doi: 10.17116/kardio202013061530
  19. McGrady A, McGinnis R, Badenhop D, et al. Effects of depression and anxiety on adherence to cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation and Prevention. 2009;29(6):358-64. doi: 10.1097/HCR.0b013e3181be7a8f
  20. Miyazaki M, Nakashima A, Nakamura Y, et al. Association between medication adherence and illness perceptions in atrial fibrillation patients treated with direct oral anticoagulants: an observational cross-sectional pilot study. PloS One. 2018;13(9):e0204814. doi: 10.1371/journal.pone.0204814
  21. Трошина Д.В. Психические расстройства у больных фибрилляцией предсердий: автореф. дисс. … канд. мед. наук. M., 2019 [Troshina DV. Psikhicheskie rasstroistva u bol'nykh fibrilliatsiei predserdii: avtoref. diss. … kand. med. nauk. Moscow, 2009 (in Russian)].
  22. Gallagher AM, Rietbrock S, Plumb J, van Staa TP. Initiation and persistence of warfarin or aspirin in patients with chronic atrial fibrillation in general practice: do the appropriate patients receive stroke prophylaxis? J Thromb Haemost. 2008;6(9):1500-6. doi: 10.1111/j.1538-7836.2008.03059.x
  23. Bauer LK, Caro MA, Beach SR, et al. Effects of depression and anxiety improvement on adherence to medication and health behaviors in recently hospitalized cardiac patients. Am J Cardiol. 2012;109(9):1266-71. doi: 10.1016/j.amjcard.2011.12.017
  24. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for non-compliance with medical treatment, meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160(14):2101-7. doi: 10.1001/archinte.160.14.2101
  25. Pilowsky I. Abnormal illness behaviour (dysnosognosia). Psychother Psychosom. 1986;46(1-2):76-84. doi: 10.1159/000287964
  26. Алехин А.Н., Трифонова Е.А., Лебедев Д.С., и др. Психологические проблемы в аритмологии (на модели фибрилляции предсердий). Вестник аритмологии. 2011;63:45-54 [Alekhin AN, Trifonova EA, Lebedev DS, et al. Psuchological problems in arrhythmology (on a model of atrial fibrillation). Vestnik aritmologii. 2011;63:45-54 (in Russian)].
  27. Reading SR, Black MH, Singer DE, et al. Risk factors for medication non-adherence among atrial fibrillation patients. BMC Cardiovasc Disord. 2019;19(1):38. doi: 10.1186/s12872-019-1019-1
  28. Quirk SE, El-Gabalawy R, Brennan SL, et al. Personality disorders and physical comorbidities in adults from the United States: data from the National Epidemiologic Survey on Alcohol and Related Conditions. Soc Psychiatry Psychiatr Epidemiol. 2015;50(5):807-20. doi: 10.1007/s00127-014-0974-1
  29. Emren SV, Şenöz O, Bilgin M, et al. Drug adherence in patients with nonvalvular atrial fibrillation taking non-vitamin K antagonist oral anticoagulants in Turkey: NOAC-TR. Clin Appl Thromb Hemost. 2018;24(3):525-31. doi: 10.1177/1076029617693940
  30. Cruess DG, Localio AR, Platt AB, et al. Patient attitudinal and behavioral factors associated with warfarin non-adherence at outpatient anticoagulation clinics. Int J Behav Med. 2010;17(1):33-42. doi: 10.1007/s12529-009-9052-6
  31. Gorst‐Rasmussen A, Skjøth F, Larsen TB, et al. Dabigatran adherence in atrial fibrillation patients during the first year after diagnosis: a nationwide cohort study. J Thromb Haemost. 2015;13(4):495-504. doi: 10.1111/jth.12845
  32. Abdou JK, Auyeung V, Patel JP, Arya R. Adherence to long‐term anticoagulation treatment, what is known and what the future might hold. Br J Haematol. 2016;174(1):30-42. doi: 10.1111/bjh.14134

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. The difference in significant indicators between the two groups: a – "extroversion" (NEO-FFI, extraversion); b – "conscientiousness" (NEO-FFI, conscientiousness); c – "general state of health" (SF-36); d – "vital activity" (SF-36); e – "role functioning, due to the emotional state" (SF-36); f – "mental health" (SF-36); g – "psychological component of health" (SF-36); h – is the total score on the SF-36 scale.

Download (174KB)
Indexing metadata
3. Fig. 2. ROC curve for the resulting logistic regression model.

Download (76KB)
Indexing metadata

Copyright (c) 2022 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies