The Effects of Warfarin and Novel Oral Anticoagulants on Depression and Anxiety in Patients with Non-Valvular Atrial Fibrillation-Uncorrected Proof

OBJECTIVE
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and has a detrimental impact on psychological well-being. This study aims to determine the prevalence of anxiety and depression in patients with non-valvular AF and to investigate the relationship between these psychological conditions and the treatment regimens administered.


METHOD
This cross-sectional study included 255 individuals diagnosed with non-valvular AF who were treated between 2021 and 2022. Psychiatric evaluation was conducted using the Beck Depression Inventory and Beck Anxiety Inventory. Multivariate regression analysis was performed to identify predictors of depression and anxiety.


RESULTS
Of the patients included, 62 were on warfarin, 124 were on novel oral anticoagulants (NOACs), and 69 were not receiving any oral anticoagulant (OAC) therapy. Overall, 68.6% had depression and 64.7% had anxiety at a moderate or higher severity level. Although there was no notable variation in anxiety and depression scores between patients on NOACs and those not undergoing OAC treatment, the warfarin group had significantly higher scores than the other two groups. Age, anxiety, C-reactive protein (CRP) levels, and CHA2DS2-VASc scores (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus, prior Stroke/transient ischemic attack-Vascular disease, Age 65-74 years, Sex category) all positively correlated with the severity of depression. Anxiety, in turn, was positively associated with age, depression, and CHA2DS2-VASc scores, and negatively associated with ejection fraction. Regression analysis revealed a strong correlation between warfarin treatment and anxiety severity.


CONCLUSION
The findings of this study suggest that warfarin treatment is associated with significant psychological effects in patients with AF. Considering that comorbid psychiatric disorders are linked to unfavorable prognosis and higher mortality, the development of appropriate intervention strategies that address psychological distress as part of the treatment process may provide substantial clinical benefits.