By Jonathan Springston, Editor, Relias-AHC Media

Recently gathered data suggest depression may increase the risk of atrial fibrillation, a common heart disorder that can cause blood clots and strokes.

Investigators created the national Multi-Ethnic Study of Atherosclerosis (MESA), and recruited more than 6,600 people from various ethnic groups to participate. Subjects presented with no known heart disease, were an average of 62 years of age, and were followed for a median of 13 years. Those who scored highest on a clinical screening test for depression and were taking anti-depressant medication demonstrated a more than 30% increased risk for developing atrial fibrillation than subjects who logged normal test scores and those not taking antidepressants.

“Our findings identify a large portion of Americans who may be at an increased risk for developing atrial fibrillation and who may benefit from more targeted efforts to prevent this arrhythmia,” said Parveen Garg, MD, MPH, assistant professor of clinical medicine at the Keck School of Medicine at USC and lead MESA investigator. “If our findings are affirmed in future studies, especially those that formally assess for clinical depression, then we will need to see if treating depression may, in fact, lower the risk for atrial fibrillation.”

Although the researchers have been unable to determine the exact link between depression and atrial fibrillation, they offered a few possible explanations, including inflammation and elevated levels of certain hormones.

“Clinicians and patients should be aware that depression has been shown in several studies to be a risk factor for heart disease in general and, in this study, for atrial fibrillation as well,” Garg added. “Treating depression is important for many reasons including cardiovascular health.”

In the upcoming April 1 issue of Emergency Medicine Reports, a group of authors provide detailed, evidence-based strategies for the management of atrial fibrillation in the ED. The authors note that rate or rhythm control approaches for patients with symptomatic atrial fibrillation yield equivalent short- and long-term clinical outcomes. Further, they found that rhythm control in appropriate patients is associated with shorter ED lengths of stay and reduced hospital admission rates. The authors conclude that all patients with atrial fibrillation should be evaluated for the need for anticoagulation to reduce the risk of stroke.

For even more on the latest research in cardiology, be sure to read Clinical Cardiology Alert, the “ECG Review” feature in Internal Medicine Alert, and STEMI Watch 2018: Advances in Diagnosis, Treatment, and Management.