title: Mental illness and warfarin use in atrial fibrillation.
abstract: OBJECTIVE
  To determine whether atrial fibrillation (AF) patients with mental health conditions (MHCs) were less likely than AF patients without MHCs to be prescribed warfarin and, if receiving warfarin, to maintain an International Normalized Ratio (INR) within the therapeutic range.
  
  
  METHODS
  Detailed chart review of AF patients using a Veterans Health Administration (VHA) facility in 2003.
  
  
  METHODS
  For a random sample of 296 AF patients, records identified clinician-diagnosed MHCs (independent variable) and AF-related care in 2003 (dependent variables), receipt of warfarin, INR values below/above key thresholds, and time spent within the therapeutic range (2.0-3.0) or highly out of range. Differences between the MHC and comparison groups were examined using X2 tests and logistic regression controlling for age and comorbidity.
  
  
  RESULTS
  Among warfarin-eligible AF patients (n = 246), 48.5% of those with MHCs versus 28.9% of those without MHCs were not treated with warfarin (P = .004). Among those receiving warfarin and monitored in VHA, highly supratherapeutic INRs were more common in the MHC group; for example, 27.3% versus 1.6% had any INR >5.0 (P <.001). Differences persisted after adjusting for age and comorbidity.
  
  
  CONCLUSIONS
  MHC patients with AF were less likely than those without MHC to have adequate management of their AF care. Interventions directed at AF patients with MHC may help to optimize their outcomes.
authors: Center for Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto, CA 94025, USA.
authors: Graham A
authors: GA
authors: Walker
authors: Paul A
authors: PA
authors: Heidenreich
authors: Ciaran S
authors: CS
authors: Phibbs
authors: Alan S
authors: AS
authors: Go
authors: Victor Y
authors: VY
authors: Chiu
authors: Susan K
authors: SK
authors: Schmitt
authors: Lakshmi
authors: L
authors: Ananth
authors: Susan M
authors: SM
authors: Frayne
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D016009:Chi-Square Distribution; D004347:Drug Interactions; D016903:Drug Monitoring; D006305:Health Status Indicators; D006801:Humans; D019934:International Normalized Ratio; D001523:Mental Disorders; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin