Impact of early rhythm control in young and middle-aged patients with depression or anxiety and new-onset atrial fibrillation

Abstract Background Atrial fibrillation (AF) is closely associated with mental health issues, with patients experiencing increased risks of both developing AF and mental distress, including anxiety and depression. Early rhythm control therapy may improve psychological outcomes in AF patients, especially those under 65 years with preexisting depression or anxiety. This study investigated whether initiating rhythm control within one year of AF diagnosis reduces healthcare utilization related to mental health in this population. Methods This study utilized data from the Korean National Health Insurance Service database, encompassing 166,797 patients under 65 years of age newly diagnosed with AF from 2010 to 2020 and with a history of depression or anxiety. Patients were divided into two groups: the Early Rhythm Control (ERC) group (receiving rhythm control within one year of diagnosis) and the usual care group. Primary outcomes included hospitalizations for depression or anxiety as the main diagnosis. Secondary outcomes encompassed hospitalizations with depression or anxiety among the top five diagnoses and psychiatric hospitalizations. Cox regression analyses and propensity score matching were used to assess outcome risks. Results During a median follow-up of 5.3 years, ERC was associated with a 28% reduced risk of primary outcome hospitalization compared to usual care (HR 0.715, 95% CI 0.63-0.81, p<0.001). Secondary outcomes also showed reduced risks: 20% for hospitalizations with depression or anxiety among the top diagnoses and 43% for any psychiatric hospitalization. After 1:1 propensity score matching, ERC continued to show a reduced risk of the primary outcome (HR 0.795, 95% CI 0.689-0.916, p=0.001), and secondary outcomes had similar findings (Figure). Subgroup analyses indicated consistent results across gender and age groups, with stronger effects observed in younger patients. Conclusion Early rhythm control therapy in patients under 65 with AF and preexisting mental health conditions is associated with significantly reduced risks of depression or anxiety-related hospitalizations and psychiatric hospitalizations. These findings suggest that early rhythm control may mitigate mental health-related healthcare utilization, underscoring the importance of timely rhythm management in this population.