title: Anticoagulation in atrial fibrillation: impact of mental illness.
abstract: OBJECTIVE
  To characterize warfarin eligibility and receipt among Veterans Health Administration (VHA) patients with and without mental health conditions (MHCs).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  This observational study identified VHA atrial fibrillation (AF) patients with and without MHCs in 2004. We examined unadjusted MHC-related differences in warfarin eligibility and warfarin receipt among warfarin-eligible patients, using logistic regression for any MHC and for specific MHCs (adjusting for sociodemographic and clinical characteristics).
  
  
  RESULTS
  Of 125,670 patients with AF, most (96.8%) were warfarin-eligible based on a CHADS2 stroke risk score. High stroke risk and contraindications to anticoagulation were both more common in patients with MHC. Warfarin-eligible patients with MHC were less likely to receive warfarin than those without MHC (adjusted odds ratio [AOR], 0.90; 95% CI, 0.87-0.94). The association between MHC and warfarin receipt among warfarin-eligible patients varied by specific MHC. Patients with anxiety disorders (AOR, 0.86; 95% CI, 0.80-0.93), psychotic disorders (AOR, 0.77; 95% CI, 0.65-0.90), and alcohol use disorders (AOR 0.62, 95% CI 0.54-0.72) were less likely to receive warfarin than patients without these conditions, whereas patients with depressive disorders and posttraumatic stress disorder were no less likely to receive warfarin than patients without these conditions.
  
  
  CONCLUSIONS
  Compared with patients with AF without MHCs, those with MHCs are less likely to be eligible for warfarin receipt and, among those eligible, are less likely to receive such treatment. Although patients with AF with MHC need careful assessment of bleeding risk, this finding suggests potential missed opportunities for more intensive therapy among some individuals with MHCs.
authors.affiliation: Health Economics Resource Center (152), Palo Alto VA Health Care System, 795 Willow Rd, Menlo Park, CA 94025. E-mail: susan.schmitt2@va.gov.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Schmitt
authors.forename: Mintu P
authors.initials: MP
authors.lastname: Turakhia
authors.forename: Ciaran S
authors.initials: CS
authors.lastname: Phibbs
authors.forename: Rudolf H
authors.initials: RH
authors.lastname: Moos
authors.forename: Dan
authors.initials: D
authors.lastname: Berlowitz
authors.forename: Paul
authors.initials: P
authors.lastname: Heidenreich
authors.forename: Vicotr Y
authors.initials: VY
authors.lastname: Chiu
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Friedman
authors.forename: Claire T
authors.initials: CT
authors.lastname: Than
authors.forename: Susan M
authors.initials: SM
authors.lastname: Frayne
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000150:complications; D000925:Anticoagulants / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000150:complications; D001281:Atrial Fibrillation / Q000150:complications*; D003866:Depressive Disorder / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D011618:Psychotic Disorders / Q000150:complications; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000150:complications; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin