Association of early rhythm control with depression outcomes in atrial fibrillation: A nationwide population-based...

Depression is common in atrial fibrillation (AF) and related to adverse prognosis. Early rhythm control (ERC) has been shown to improve cardiovascular outcomes in AF; however, its impact on depression remains less understood.

To investigate the association between ERC and the risk of depression onset or worsening.

We analyzed 533,328 patients with AF from the National Health Information Database, categorized by prior depression (group A: without; group B: with). According to the ERC status (the initiation of rhythm control within 1 year of AF diagnosis), we evaluated new-onset depression in group A and hospital admission for depression-related or any psychiatric condition in group B.

Of the total patients, 349,804 (65.6%) were group A (mean age, 62.8 years; male, 63.8%) and 183,524 (34.4%) were group B (mean age, 65.6 years; male, 45.8%). The proportion of patients receiving ERC was 30.1% in group A and 27.7% in group B. In group A, ERC was associated with a lower risk of new-onset depression: adjusted hazard ratio (aHR) of 0.963 with 95% confidence interval (CI) of 0.946-0.980 (P < .001). In group B, ERC was associated with a lower risk of hospital admission for depression as a principal diagnostic code (aHR = 0.714 [95% CI: 0.619-0.822], P < .001), depression listed among the top 5 diagnostic codes (aHR = 0.812 [95% CI, 0.777-0.848], P < .001), and any psychiatric condition (aHR = 0.652 [95% CI, 0.605-0.703], P < .001) than usual care group. The lower risk of hospital admission for depression associated with ERC was more pronounced among younger (<65 years) and male patients with AF.

ERC is associated with a lower risk of depression onset or worsening in patients with AF.