Nonvalvular atrial fibrillation during chronic stress in the context of war in Ukraine: integrating mental health, pathophysiology, and pharmacotherapy in to a future-oriented model of care

Mental health disorders resulting from war-related stress may interact with cardiovascular risk factors, highlighting the importance of understanding the course of nonvalvular atrial fibrillation (nAF) and the organization of medical care in resource-limited settings. Objective To analyze evidence-based medicine (EBM) data on the mutual influence of atrial fibrillation (AF), chronic psychosocial stress, and mental health disorders with subsequent modeling of a future-oriented conceptual model of integrated patient-centered medical care for patients with nAF in wartime and post-war reconstruction of the Healthcare system in Ukraine. Methods A narrative review of EBM data on epidemiological trends, pathophysiology of nAF, mental health, pharmacotherapy, Drug-Drug Interactions (DDI), patient-oriented, and digital interventions was conducted. Results The relationships of psycho-emotional, cardiometabolic, behavioral and socioeconomic factors with the risk of onset and course of nAF were identified. Potential common mechanisms are dysregulation of the autonomic and hypothalamic-pituitary-adrenal systems, inflammation, oxidative stress, endothelial dysfunction and atrial remodeling. Mental health disorders can affect symptom burden, adherence to treatment, quality of life and safety of pharmacotherapy. A future-oriented conceptual integrated multidisciplinary model of Healthcare system was modeled. Conclusions The analyzed data confirm the associative biopsychosocial links of nAF in conditions of chronic stress, but do not allow us to unambiguously establish the causal effect of chronic war stress on the development and progression of nAF. A future-oriented integrated conceptual model can be the basis for adapting medical care to war conditions and the post-war period in Healthcare system.