Int J Cardiol Cardiovasc Risk Prev. 2026 Aug 24;31:200704. doi: 10.1016/j.ijcrp.2026.200704. eCollection 2026 Dec.
ABSTRACT
BACKGROUND: Psychiatric disorders are associated with adverse cardiovascular outcomes, but their independent associations with atrial fibrillation (AF) and acute coronary syndrome (ACS), accounting for psychiatric comorbidity and age-related differences, remain unclear. This study evaluated the associations of depression, anxiety disorders, and bipolar disorder with AF and ACS in hospitalized adults.
METHODS: We conducted a retrospective cross-sectional analysis of the 2017-2020 Healthcare Cost and Utilization Project National Inpatient Sample. Hospitalizations among adults aged 18-90 years were included. Survey-weighted multivariable logistic regression models were constructed separately for AF and ACS and adjusted for sex, race or ethnicity, calendar year, cardiovascular risk factors, and coexisting psychiatric disorders. Hypertension included essential, secondary, resistant, and crisis hypertension, as well as hypertensive heart or kidney disease. Domain analyses were performed among adults aged 18-39 years, and interactions of age group with depression, anxiety disorders, bipolar disorder, and hypertension were evaluated.
RESULTS: The age-restricted dataset contained 23,713,289 discharge records; fully adjusted complete-case models included 23,068,920 records, representing 115,344,584 weighted hospitalizations. In the full models, depression was associated with slightly higher odds of AF (adjusted OR, 1.041; 95% CI, 1.037-1.045), whereas anxiety disorders (0.970; 0.966-0.974) and bipolar disorder (0.848; 0.841-0.855) were associated with lower odds. Depression (0.711; 0.704-0.718), anxiety disorders (0.862; 0.854-0.870), and bipolar disorder (0.504; 0.492-0.516) were associated with lower odds of ACS. Hypertension was associated with higher odds of both AF (2.615; 2.598-2.633) and ACS (2.103; 2.080-2.126). Among adults aged 18-39 years, depression and anxiety disorders were associated with higher odds of AF, while bipolar disorder was not significant. All three psychiatric exposures were associated with lower odds of ACS in this subgroup. Age interactions were significant for the psychiatric exposures and hypertension for AF; for ACS, the age interactions were significant for depression, bipolar disorder, and hypertension, but not anxiety.
CONCLUSIONS: Psychiatric diagnoses showed small but statistically significant, outcome- and age-dependent associations with AF and ACS after multivariable adjustment. Because these are hospitalization-level cross-sectional associations, they should not be interpreted as causal or protective. Longitudinal studies are needed to clarify the temporal and biological mechanisms underlying these findings.
PMID:42750723 | PMC:PMC13577834 | DOI:10.1016/j.ijcrp.2026.200704