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

OBJECTIVE
Atrial fibrillation (AF) represents 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 a total of 255 individuals diagnosed with non-valvular AF who were treated between 2021 and 2022. Psychiatric evaluation of the patients was conducted using the Beck Depression and Beck Anxiety Inventories. Multivariate regression analysis was performed to determine the 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. Of the patients, 68.6% had depression and 64.7% had anxiety depending on moderate or higher severity level. Although there was no notable variation in anxiety and depression scores between NOAC patients and those not undergoing any OAC treatment, the warfarin group had much higher scores than the other two groups. Age, anxiety, CRP levels, and CHA2DS2-VASc scores all positively correlated with the severity of depression. Anxiety, on the other hand, was positively related to age, depression, and CHA2DS2-VASc scores and negatively related to ejection fraction. The regression analysis revealed a strong correlation between warfarin treatment and anxiety severity.

CONCLUSION
The findings of this study suggest that the administration of warfarin leads to significant psychological effects in AF patients. Considering that comorbid psychiatric disorders are associated with 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.