Abstract DP265: Association Between Mental Health Disorders and Anticoagulation Adherence in Patients with Non-Valvular Atrial Fibrillation (NVAF) in Kaiser Permanente Southern California Patients

Introduction: Non-valvular atrial fibrillation (NVAF) increases ischemic stroke risk, making anticoagulation adherence critical. The effectiveness of direct oral anticoagulants (DOACs) and warfarin depends on consistent adherence. Although depression has been linked to lower anticoagulant adherence, the impact of other psychiatric disorders is less understood. We evaluated the association between mood and psychotic disorders and anticoagulation adherence among NVAF patients in a Southern California integrated health system. Methods: We retrospectively collected data from 15 hospitals between January 1, 2017, and December 31, 2022. Baseline demographic data, vascular risk factors, anticoagulation type and mental health disorders were gathered. Anticoagulation adherence was quantified using proportion of days covered (PDC) and categorized as nonadherent (<80%), adequate (≥80% to <90%), or optimal (≥90%). Adherence was assessed for one year following the NVAF index date. Bivariate comparisons were conducted using chi-squared and Wilcoxon rank-sum tests. Multinomial logistic regression was used to evaluate the association between mental health disorders and anticoagulation adherence. Results: We identified 18,139 NVAF patients who initiated DOACs or warfarin; 55.4% were female and the mean age was 72.6 ± 5.3 years. Overall, 18.8% (n=3,417) had a documented mental health disorder. Mental health disorders were not associated with differences in adequate adherence (PDC ≥80% to <90%) for either DOACs or warfarin. Patients with mental health disorders had lower odds of optimal adherence (PDC ≥90%) with DOACs in minimally adjusted models (OR 0.87, 95% CI 0.78–0.96; P = .008). No association was observed between mental health disorders and optimal adherence to warfarin. Conclusions: Among NVAF patients mental health disorders were not associated with adequate anticoagulation adherence; they were linked to lower odds of optimal adherence with DOACs, though this association was attenuated byclinical and social factors. The lack of association may reflect the support and monitoring provided within an integrated, closed-loop healthcare system. These findings suggest that while NVAF patients with comorbid mental health disorders may be at risk for suboptimal DOAC adherence, system-level supports may help mitigate these gaps.