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    Medical Management

    Selective Serotonin Reuptake Inhibitors and Stroke in Atrial Fibrillation Patients with different CHA₂DS₂-VASc scores

    Ala Assaf, n/a – Research Fellow, Tulane University School of Medicine; Ghassan Bidaoui, N/A – Research Fellow, Tulane University School of Medicine; Mayana Bsoul, N/A – Research Fellow, Tulane University School of Medicine; Nadia Chouman, N/A – Research Fellow, Tulane University School of Medicine; Nour Chouman, N/A – Research Fellow, Tulane University School of Medicine; Alexander Dahl, N/A – Medical Student, Tulane School of Medicine; Han Feng, Ph.D – Faculty, Tulane University School of Medicine; Yuxuan Gu, N/A – Biostatistician, UT Health Houston; Yishi Jia, N/A – Biostatistician, Tulane University School of Medicine; Yingshuo Liu, B.S. – Biostatistician, Tulane School of Medicine; Emma Lunn, Medical Student – Medical Student, Tulane University School of Medicine; Nassir Marrouche, M.D. – Professor of Medicine, Tulane University School of Medicine; Cecile McGarvey, N/A – Medical Student, Tulane University School of Medicine; Amitabh Pandey, M.D – Assistant Professor, Tulane University School of Medicine; Swati Rao, M.D – Assistant Professor, Tulane University School of Medicine; Francisco Tirado, M.D. Ph.D – Faculty, Tulane University School of Medicine; Hadi Younes, N/A – Research Fellow, Tulane School of Medicine
    Purpose: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is responsible for an estimated >70,000 ischemic strokes annually. Previous investigation has found that selective serotonin reuptake inhibitors (SSRI) may be associated with increased stroke in the atrial fibrillation (AF) population regardless of indication and other psychotropic medications. CHA₂DS₂-VASc is utilized to assess stroke risk in AF patients but does not consider psychotropic medication use. We aim to assess the impact of SSRI use on stroke incidence among patients with varying stroke risk based on CHA₂DS₂-VASc.

    Material and Methods: 5,947 patients with AF evaluated at Tulane Medical Center were identified from the REACHnet New Orleans Registry and split into 5 groups based on their CHA₂DS₂-VASc assessment score, either 0 (n= 1,969),1 (n=1593) ,2 (n=1,020) ,3 (n=712) or ≥4 (n=653). Within each scoring group, patients on SSRIs were compared to those not on SSRIs for time to stroke following AF diagnosis, using Kaplan Meier. An adjusted Cox proportional hazards model accounting for SSRIs, CHA₂DS₂-VASc, BMI, gender, and diagnoses of mental health disorders was preformed.

    Results: SSRI use was associated significantly with shorter time to stroke in patients with CHA₂DS₂-VASc score of 3 (HR 2.43, p<.0001). In all other groups, SSRI use was associated with a statistically nonsignificant shorter time to stroke. On adjusted multivariate analysis, SSRI use was linked to 52% higher risk of experiencing stroke (p <.0001).

    Conclusions: SSRI use in the AF population is most significantly associated with increased risk stroke among patients with CHA₂DS₂-VASc score of 3. Further investigation is needed to assess the implications of this finding in psychiatric and hemostatic treatment decisions.