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首页> 外文期刊>The journal of clinical psychiatry >Antidepressants and Atrial Fibrillation: The Importance of Resourceful Statistical
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Antidepressants and Atrial Fibrillation: The Importance of Resourceful Statistical

机译：抗抑郁药和心房颤动：资源统计的重要性

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Atrial fibrillation (AF) is the most common cardiac arrhythmia. Antidepressant drugs are known to influence cardiac conduction, and there are theoretical grounds to suggest that serotonin reuptake inhibition by antidepressants may predispose to AF. A large register-based cohort study found that antidepressant use was associated with an increased risk of AF during the first month following antidepressant initiation. Whereas this may seem alarming, additional analyses found that the risk progressively diminished in succeeding months. Further analysis showed that antidepressant use was associated with an even higher risk of AF in the month before antidepressant initiation; this finding implies that patients who initiate antidepressant drugs are already at increased risk of AF and that the significant association between antidepressant drug use and AF might be because of confounding by indication. In other words, the indication for antidepressant use rather than antidepressant use, itself, may be the risk factor for AF, and this risk is probably state-dependent because it diminishes with the passage of time, during which period the indication for antidepressant use presumably resolves. In another study, which used a nested case-control design, current and recent users of antidepressant drugs were contrasted not with antidepressant nonusers but with past users of antidepressants. The study found that neither current nor recent users were at increased risk of AF. This again indicates that antidepressants are unlikely to directly predispose to AF. In both studies, the possibility of confounding by indication was addressed by resourceful statistical approaches to the research question. Such resourcefulness in analysis is necessary in all observational studies of the association between an exposure and an outcome. In the absence of efforts to address confounding by indication, an identified association between an exposure and an outcome should not be presumed to reflect a cause-effect relationship.
机译：心房颤动（AF）是最常见的心脏心律失常。已知抗抑郁药物影响心脏传导，并且有理论措施表明抗抑郁药的血清素再摄取抑制可能易于到AF。发现基于大的寄存器的队列研究发现，抗抑郁发芽后的第一个月内的AF的风险增加有关。虽然这似乎令人震惊，但额外的分析发现，在后续几个月里，风险逐渐减少。进一步的分析表明，抗抑郁发芽前的月份的抗抑郁药用途与甚至更高的AF风险有关;这种发现意味着引发抗抑郁药物的患者已经增加了AF的风险增加，并且抗抑郁药物使用和AF之间的重要关联可能是因为通过指示的混杂性。换句话说，抗抑郁药用途而不是抗抑郁用途本身的指示可以是AF的危险因素，并且这种风险可能是依赖的，因为它随着时间的推移而减少，在此期间可能是抗抑郁药的指示解决了。在另一项研究中，使用嵌套案例控制设计，抗抑郁药物的最新用户与抗抑郁症的抗抑郁症的抗衰号呈对比，而是与过去的抗抑郁药用途。该研究发现，目前也不是最近的用户都会增加AF的风险。这再次表明抗抑郁药不太可能直接倾向于AF。在这两项研究中，通过针对研究问题的资源丰富的统计方法解决了征兆的可能性。在暴露和结果之间的关联的所有观察研究中，这种智慧分析是必要的。在没有努力通过指征解决混淆的努力，不应推测曝光与结果之间的确定关联以反映造成效应关系。

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