Association Between Bipolar Disorder or Schizophrenia and Oral Anticoagulation Use in Danish Adults With Incident or Prevalent Atrial Fibrillation

Key Points Question Is bipolar disorder or schizophrenia associated with lower use of anticoagulation therapy, which is a guideline recommendation for stroke prevention in patients with atrial fibrillation? Findings In this nationwide cohort study of more than 150 000 Danish patients with atrial fibrillation, comorbid bipolar disorder and schizophrenia were associated with a lower likelihood of receiving anticoagulation. Particularly for patients with schizophrenia, this treatment deficit persistently exceeded that explained by socioeconomic characteristics or additional comorbidity, although improvement was seen after new oral anticoagulants were introduced. Meaning Patients with psychiatric comorbidity may face disparity in stroke prevention after a diagnosis of atrial fibrillation, but results of this study suggest that these patients may benefit from increasing access to newer oral anticoagulants.