title: Depression or anxiety and all-cause mortality in adults with atrial fibrillation--A cohort study in Swedish primary care.
abstract: OBJECTIVE
  Our aim was to study depression and anxiety in atrial fibrillation (AF) patients as risk factors for all-cause mortality in a primary care setting.
  
  
  METHODS
  The study population included adults (n = 12 283) of 45 years and older diagnosed with AF in 75 primary care centres in Sweden. The association between depression or anxiety and all-cause mortality was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). Analyses were conducted in men and women, adjusted for age, educational level, marital status, neighborhood socio-economic status (SES), change of neighborhood status and anxiety or depression, respectively, and cardiovascular co-morbidities. As a secondary analysis, background factors and their association with depression or anxiety were explored.
  
  
  RESULTS
  The risk of all-cause mortality was higher among men with depression compared to their counterparts without depression even after full adjustment (HR = 1.28, 95% CI 1.08-1.53). For anxiety among men and anxiety or depression among women with AF, no associations were found. Cerebrovascular disease was more common among depressed AF patients.
  
  
  CONCLUSIONS
  Increased awareness of the higher mortality among men with AF and subsequent depression is called for. We suggest a tight follow-up and treatment of both ailments in clinical practice.
authors.affiliation: a Division of Family Medicine, Department of Neurobiology , Care Sciences and Society (NVS), Karolinska Institutet , Huddinge , Sweden ;|b Academic Primary Care Centre, Stockholm County Council , Huddinge , Sweden ;
authors.forename: Per
authors.initials: P
authors.lastname: Wändell
authors.affiliation: a Division of Family Medicine, Department of Neurobiology , Care Sciences and Society (NVS), Karolinska Institutet , Huddinge , Sweden ;|b Academic Primary Care Centre, Stockholm County Council , Huddinge , Sweden ;|c Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory , Uppsala University , Uppsala , Sweden ;
authors.forename: Axel C
authors.initials: AC
authors.lastname: Carlsson
authors.affiliation: d Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh , Edinburgh , UK ;
authors.forename: Danijela
authors.initials: D
authors.lastname: Gasevic
authors.affiliation: e Centre for Psychiatry Research, Karolinska Institutet , Stockholm , Sweden ;
authors.forename: Lars
authors.initials: L
authors.lastname: Wahlström
authors.affiliation: f Center for Primary Health Care Research, Lund University , Malmö , Sweden ;|g Stanford Prevention Research Center, Stanford University School of Medicine , Palo Alto , California , USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Sundquist
authors.affiliation: f Center for Primary Health Care Research, Lund University , Malmö , Sweden ;|g Stanford Prevention Research Center, Stanford University School of Medicine , Palo Alto , California , USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Sundquist
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology; D001281:Atrial Fibrillation / Q000401:mortality* / Q000523:psychology*; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology
keywords: Anticoagulants; anxiety; atrial fibrillation; co-morbidity; depression; follow-up; gender; mortality