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9. Time-in-therapeutic-range defined warfarin and direct oral anticoagulants in atrial fibrillation: a Nationwide Cohort Study.

Author

Lehto, Mika, Luojus, Alex, Halminen, Olli, Haukka, Jari, Putaala, Jukka, Linna, Miika, Mustonen, Pirjo, Kinnunen, Janne, Lehtonen, Ossi, Teppo, Konsta, Tiili, Paula, Kouki, Elis, Itäinen-Strömberg, Saga, Niemi, Mikko, Aro, Aapo L., Hartikainen, Juha, and Juhani Airaksinen, K. E.

Subjects
ORAL medication, ATRIAL fibrillation, ISCHEMIC stroke, WARFARIN, SAFETY standards
Abstract

Background: Little is known how individual time-in-therapeutic-range (TTR) impacts the effectiveness and safety of warfarin therapy compared to direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF). Objective: To compare the effectiveness and safety of standard dose DOACs to warfarin in patients with AF, while categorizing warfarin treated patients into quartiles based on their individual TTR. Materials and methods: We conducted a nationwide study including all patients with new-onset AF between 2011 and 2018 in Finland. Hazard ratios (HR) were calculated using Cox regression analysis with the inverse probability of treatment weighted method to assess the risks of ischaemic stroke (IS), intracranial haemorrhage (ICH) and mortality for users of apixaban (n = 12,426), dabigatran (n = 4545), rivaroxaban (n = 12,950) and warfarin (n = 43,548). Results: The median TTR for warfarin users was 72%. Compared to the second best TTR quartile (reference), the risk of IS was higher in the two poorest TTR quartiles, and lower in the best TTR quartile and on rivaroxaban [2.35 (95% confidence interval, 1.85-2.85), 1.44 (1.18-1.75), 0.60 (0.47-0.77) and 0.72 (0.56-0.92)]. These differences were non-significant for apixaban and dabigatran. HR of ICH was 6.38 (4.88-8.35) and 1.87 (1.41-2.49) in the two poorest TTR groups, 1.44 (1.02-1.93) on rivaroxaban, and 0.58 (0.40-0.85) in the best TTR group compared to the reference group. Mortality was higher in the two poorest TTR groups and lowest in the best TTR group. Conclusions: The outcome was unsatisfactory in the two lowest TTR quartiles - in half of the patients treated with warfarin. The differences between the high TTR groups and standard dose DOACs were absent or modest. [ABSTRACT FROM AUTHOR]

Published
2024
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10. Rural–urban and geographical differences in prognosis of atrial fibrillation in Finland: a nationwide cohort study.

Author

Teppo, Konsta, Airaksinen, K.E. Juhani, Halminen, Olli, Jaakkola, Jussi, Linna, Miika, Haukka, Jari, Putaala, Jukka, Mustonen, Pirjo, Kinnunen, Janne, Hartikainen, Juha, and Lehto, Mika

Subjects
RESEARCH funding, POPULATION geography, LONGITUDINAL method, AGE factors in disease, RURAL conditions, METROPOLITAN areas, ATRIAL fibrillation, ISCHEMIC stroke, CONFIDENCE intervals, DISEASE risk factors
Abstract

Aims: Rural–urban disparities have been reported in the outcomes of cardiovascular diseases. We assessed whether rural–urban or other geographical disparities exist in the risk of ischemic stroke (IS) and death in patients with atrial fibrillation (AF) in Finland. Methods: The registry-based FinACAF cohort study covers all patients with AF from all levels of care in Finland from 2007 to 2018. Patients were divided into rural–urban categories and into hospital districts (HDs) based on their municipality of residence. Results: We identified 222,051 patients (50.1% female; mean age 72.8 years; mean follow-up 3.9 years) with new-onset AF, of whom 15,567 (7.0%) patients suffered IS and 72,565 (32.7%) died during follow-up. The crude IS rate was similar between rural and urban areas, whereas the mortality rate was lower in urban areas (incidence rate ratios (IRRs) with 95% confidence intervals (CIs) 0.97 (0.93–1.00) and 0.92 (0.91–0.93), respectively). However, after adjustments, urban residence was associated with slightly higher IS and mortality rates (IRRs with 95% CIs 1.05 (1.01–1.08) and 1.06 (1.04–1.07), respectively). The highest crude IS rate was in the East Savo HD and the lowest in Åland, whereas the highest crude mortality rate was in the Länsi-Pohja HD and the lowest in the North Ostrobothnia HD (IRRs with 95% CIs compared to Helsinki and Uusimaa HD for IS 1.46 (1.28–1.67) and 0.79 (0.62–1.01), and mortality 1.24 (1.16–1.32) and 0.97 (0.93–1.00), respectively. Conclusions: Rural–urban differences in prognosis of AF in Finland appear minimal, whereas considerable disparities exist between HDs. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Sex- and age-specific differences in the use of antiarrhythmic therapies among atrial fibrillation patients: a nationwide cohort study.

Author

Salmela, Birgitta, Jaakkola, Jussi, Kalatsova, Ksenia, Inkovaara, Jaakko, Aro, Aapo L, Teppo, Konsta, Penttilä, Tero, Halminen, Olli, Haukka, Jari, Putaala, Jukka, Linna, Miika, Mustonen, Pirjo, Hartikainen, Juha, Airaksinen, K E Juhani, and Lehto, Mika

Abstract

Aims Atrial fibrillation (AF) patients frequently require active rhythm control therapy to maintain sinus rhythm and reduce symptom burden. Our study assessed whether antiarrhythmic therapies (AATs) are used disproportionately between men and women after new-onset AF. Methods and results The nationwide Finnish anticoagulation in AF registry-based linkage study covers all patients with new-onset AF in Finland during 2007–2018. Study outcomes included initiation of AATs in the form of antiarrhythmic drugs (AADs), cardioversion, or catheter ablation. The study population constituted of 229 565 patients (50% females). Women were older than men (76.6 ± 11.8 vs. 68.9 ± 13.4 years) and had higher prevalence of hypertension or hyperthyroidism, but lower prevalence of vascular disease, diabetes, renal disease, and cardiomyopathies than men. Overall, 17.6% of women and 25.1% of men were treated with any AAT. Women were treated with AADs more often than men in all age groups [adjusted subdistribution hazard ratio (aSHR) 1.223, 95% confidence interval (CI) 1.187–1.261]. Cardioversions were also performed less often on women than on men aged <65 years (aSHR 0.722, 95% CI 0.695–0.749), more often in patients ≥ 75 years (aSHR 1.166, 95% CI 1.108–1.227), while no difference between the sexes existed in patients aged 65–74 years. Ablations were performed less often in women aged <65 years (aSHR 0.908, 95% CI 0.826–0.998) and ≥75 years (aSHR 0.521, 95% CI 0.354–0.766), whereas there was no difference in patients aged 65–74 years. Conclusion Women used more AAD than men in all age groups but underwent fewer cardioversion and ablation procedures when aged <65 years. [ABSTRACT FROM AUTHOR]

Published
2024
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16. Thromboembolic and bleeding complications after elective cardioversion of atrial fibrillation: a nationwide cohort study.

Author

Itäinen-Strömberg, Saga, Lehto, Mika, Halminen, Olli, Putaala, Jukka, Haukka, Jari, Lehtonen, Ossi, Teppo, Konsta, Mustonen, Pirjo, Linna, Miika, Hartikainen, Juha, Airaksinen, Kari Eino Juhani, and Aro, Aapo L

Abstract

Aims Elective cardioversion (ECV) is routinely used in atrial fibrillation (AF) to restore sinus rhythm. However, it includes a risk of thromboembolism even during adequate oral anticoagulation treatment. The aim of this study was to evaluate the risk of thromboembolic and bleeding complications after ECV in a real-life setting utilizing data from a large AF population. Methods and results This nationwide register-based study included all (n = 9625) Finnish AF patients undergoing their first-ever ECV between 2012 and 2018. The thromboembolic and bleeding complications within 30 days after ECV were analysed. The mean age of the patients was 67.7 ± 9.9 years, 61.2% were men, and the mean CHA2DS2-VASc score was 2.6 ± 1.6. Warfarin was used in 6245 (64.9%) and non-vitamin K oral anticoagulants (NOACs) in 3380 (35.1%) cardioversions. Fifty-two (0.5%) thromboembolic complications occurred, of which 62% were ischaemic strokes, 25% transient ischaemic attacks, and 13% other systemic embolisms. Thromboembolic events occurred in 14 (0.4%) NOAC-treated patients and in 38 (0.6%) warfarin-treated patients (odds ratio 0.77; confidence interval: 0.42–1.39). The median time from ECV to the thromboembolic event was 2 days, and 78% of the events occurred within 10 days. Age and alcohol abuse were significant predictors of thromboembolic events. Among warfarin users, thromboembolic complications were more common with international normalized ratio (INR) <2.5 than INR ≥2.5 (0.9% vs. 0.4%, P = 0.026). Overall, 27 (0.3%) bleeding events occurred. Conclusion The rate of thromboembolic and bleeding complications related to ECV was low without significant difference between NOAC- and warfarin-treated patients. With warfarin, INR ≥2.5 at the time of cardioversion reduced the risk of thromboembolic complications. [ABSTRACT FROM AUTHOR]

Published
2024
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17. Ischaemic stroke in women with atrial fibrillation: temporal trends and clinical implications.

Author

Teppo, Konsta, Airaksinen, K E Juhani, Jaakkola, Jussi, Halminen, Olli, Salmela, Birgitta, Kouki, Elis, Haukka, Jari, Putaala, Jukka, Linna, Miika, Aro, Aapo L, Mustonen, Pirjo, Hartikainen, Juha, Lip, Gregory Y H, and Lehto, Mika

Subjects
ISCHEMIC stroke, ATRIAL fibrillation, ORAL medication, CURRICULUM
Abstract

Background and Aims Female sex has been linked with higher risk of ischaemic stroke (IS) in atrial fibrillation (AF), but no prior study has examined temporal trends in the IS risk associated with female sex. Methods The registry-linkage Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study included all patients with AF in Finland from 2007 to 2018. Ischaemic stroke rates and rate ratios were computed. Results Overall, 229 565 patients with new-onset AF were identified (50.0% women; mean age 72.7 years). The crude IS incidence was higher in women than in men across the entire study period (21.1 vs. 14.9 events per 1000 patient-years, P <.001), and the incidence decreased both in men and women. In 2007–08, female sex was independently associated with a 20%–30% higher IS rate in the adjusted analyses, but this association attenuated and became statistically non-significant by the end of the observation period. Similar trends were observed when time with and without oral anticoagulant (OAC) treatment was analysed, as well as when only time without OAC use was considered. The decrease in IS rate was driven by patients with high IS risk, whereas in patients with low or moderate IS risk, female sex was not associated with a higher IS rate. Conclusions The association between female sex and IS rate has decreased and become non-significant over the course of the study period from 2007 to 2018, suggesting that female sex could be omitted as a factor when estimating expected IS rates and the need for OAC therapy in patients with AF. [ABSTRACT FROM AUTHOR]

Published
2024
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21. Temporal trends of gender disparities in oral anticoagulant use in patients with atrial fibrillation.

Author

Teppo, Konsta, Airaksinen, K. E. Juhani, Jaakkola, Jussi, Halminen, Olli, Salmela, Birgitta, Kalatsova, Ksenia, Kouki, Elis, Haukka, Jari, Putaala, Jukka, Linna, Miika, Aro, Aapo L., Mustonen, Pirjo, Hartikainen, Juha, and Lehto, Mika

Subjects
ATRIAL fibrillation, ORAL medication, GENDER inequality, DISEASE risk factors
Abstract

Aims: To investigate sex‐specific temporal trends in the initiation of oral anticoagulant (OAC) therapy among patients diagnosed with atrial fibrillation (AF) in Finland between 2007 and 2018. Methods: The registry‐linkage Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) Study included all patients with incident AF in Finland from 2007 to 2018. The primary outcome was the initiation of any OAC therapy. Results: We identified 229,565 patients with new‐onset AF (50.0% women; mean age 72.7 years). The initiation of OAC therapy increased continuously during the observation period. While women were more likely to receive OAC therapy overall, after adjusting for age, stroke risk factors and other confounding factors, female sex was associated with a marginally lower initiation of OACs (unadjusted and adjusted hazard ratios comparing women to men: 1.08 (1.07–1.10) and 0.97 (0.96–0.98), respectively). Importantly, the gender disparities in OAC use attenuated and reached parity by the end of the observation period. Furthermore, when only patients eligible for OAC therapy according to the contemporary guidelines were included in the analyses, the gender inequalities in OAC initiation appeared minimal. Implementation of direct OACs for stroke prevention was slightly slower among women. Conclusion: This nationwide retrospective cohort study covering all patients with incident AF in Finland from 2007 to 2018 observed that although female sex was initially associated with a lower initiation of OAC therapy, the sex‐related disparities resolved over the course of the study period. [ABSTRACT FROM AUTHOR]

Published
2024
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27. Socioeconomic factors and bleeding events in patients with incident atrial fibrillation

Author

Teppo, Konsta, Jaakkola, Jussi, Biancari, Fausto, Halminen, Olli, Linna, Miika, Putaala, Jukka, Mustonen, Pirjo, Kinnunen, Janne, Jolkkonen, Santeri, Niemi, Mikko, Hartikainen, Juha, Airaksinen, K. E.Juhani, Lehto, Mika, University of Turku, University of Helsinki, Department of Industrial Engineering and Management, Turku University Hospital, Tampere University, University of Eastern Finland, Aalto-yliopisto, and Aalto University

Subjects
Income, educational attainment, Bleeding risk, Socioeconomic status, Adverse outcomes, Atrial fibrillation
Abstract

Funding Information: Conflict of Interest Disclosures:, Konsta Teppo: Research grants: The Finnish Foundation for Cardiovascular Research. Jussi Jaakkola: none. Fausto Biancari: none Olli Halminen: none. Jukka Putaala: Dr. Putaala reports personal fees from Boehringer-Ingelheim, personal fees and other from Bayer, grants and personal fees from BMS-Pfizer, personal fees from Portola, other from Amgen, personal fees from Herantis Pharma, personal fees from Terve Media, other from Vital Signum, personal fees from Abbott, outside the submitted work. Pirjo Mustonen: Consultant: Roche, BMS-Pfizer-alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. Miika Linna: Speaker: BMSPfizer-alliance, Bayer, Boehringer-Ingelheim. Juha Hartikainen: Research grants: The Finnish Foundation for Cardiovascular Research, EU Horizon 2020, EU FP7. Advisory Board Member: BMS-Pfizer-alliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. K.E. Juhani Airaksinen: Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer-Ingelheim. Member in the advisory boards: Bayer, Pfizer and AstraZeneca. Mika Lehto: Consultant: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, and MSD; Speaker: BMS-Pfizer-alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer-Ingelheim. This work was supported by the Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund (TYH2019309). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Funding Information: This work was supported by the Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund ( TYH2019309 ). Funding Information: Konsta Teppo: Research grants: The Finnish Foundation for Cardiovascular Research. Jussi Jaakkola: none. Fausto Biancari: none Olli Halminen: none. Jukka Putaala: Dr. Putaala reports personal fees from Boehringer-Ingelheim, personal fees and other from Bayer, grants and personal fees from BMS-Pfizer, personal fees from Portola, other from Amgen, personal fees from Herantis Pharma, personal fees from Terve Media, other from Vital Signum, personal fees from Abbott, outside the submitted work. Pirjo Mustonen: Consultant: Roche, BMS-Pfizer-alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. Miika Linna: Speaker: BMSPfizer-alliance, Bayer, Boehringer-Ingelheim. Juha Hartikainen: Research grants: The Finnish Foundation for Cardiovascular Research, EU Horizon 2020, EU FP7. Advisory Board Member: BMS-Pfizer-alliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. K.E. Juhani Airaksinen: Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer-Ingelheim. Member in the advisory boards: Bayer, Pfizer and AstraZeneca. Mika Lehto: Consultant: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, and MSD; Speaker: BMS-Pfizer-alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer-Ingelheim. Publisher Copyright: © 2022 The Author(s) Background: Low socioeconomic status has been associated with higher risk of ischemic stroke and death in patients with atrial fibrillation (AF). However, whether socioeconomic status affects risk of bleeding events is unknown. We assessed the hypothesis that low income and educational attainment are associated with higher risk of bleeding in patients with AF. Methods: The registry-based FinACAF study covers all patients with AF in Finland during 2007–2018. Patients were divided into income quartiles and three categories based on their educational attainment. Outcomes of interest were the first-ever gastrointestinal (GI), intracranial (IC) and any bleeding. Results: We identified 205 019 patients (50.9 % female; mean age 72.3 (SD 13.4) years) with incident AF without prior bleeding. Mean follow-up time was 4.0 (SD 3.2) years, during which 25 013 (12.2 %) patients experienced first-ever any bleeding (incidence rate 3.07 (95 % CI 3.03–3.10) /100 patient-years). Low income was independently associated with hazard of any bleeding as well as GI and IC bleeding (adjusted hazard ratios (HRs) comparing lowest vs highest income quartile: 1.13 (1.08–1.17), 1.32 (1.23–1.41) and 1.15 (1.06–1.24), respectively). Income-related bleeding disparities were larger among younger patients under 65 years and among men. Education-related bleeding disparities were smaller than income related-disparities (adjusted HRs comparing lowest vs highest educational category: any bleeding 1.06 (1.02–1.11), GI bleeding 1.16 (1.08–1.24), IC bleeding 1.10 (0.93–1.09)) Conclusions: Patients with AF and low income are at higher risk of bleeding, especially GI bleeding.

Published
2022

29. Mental health conditions and risk of first-ever ischaemic stroke and death in patients with incident atrial fibrillation

Author

Teppo, Konsta, Jaakkola, Jussi, Biancari, Fausto, Halminen, Olli, Putaala, Jukka, Mustonen, Pirjo, Haukka, Jari, Linna, Miika, Kinnunen, Janne, Tiili, Paula, Kouki, Elis, Penttilä, Tero, Hartikainen, Juha, Aro, Aapo L., Airaksinen, K. E.Juhani, Lehto, Mika, University of Turku, University of Helsinki, Department of Industrial Engineering and Management, Turku University Hospital, Tampere University, University of Eastern Finland, Aalto-yliopisto, and Aalto University

Subjects
ischaemic stroke, mental health conditions, psychiatric disorders, atrial fibrillation, mortality
Abstract

Funding Information: Jukka Putaala: Dr. Putaala reports personal fees from Boehringer Ingelheim, personal fees and other from Bayer, grants and personal fees from BMS‐Pfizer, personal fees from Portola, other from Amgen, personal fees from Herantis Pharma, personal fees from Terve Media, other from Vital Signum, personal fees from Abbott, outside the submitted work. Pirjo Mustonen: Consultant: Roche, BMS‐Pfizer‐alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. Jari Haukka: Consultant: Research Janssen R&D; Speaker: Bayer Finland. Miika Linna: Speaker: BMS‐Pfizer‐alliance, Bayer, Boehringer Ingelheim. Juha Hartikainen: Research grants: The Finnish Foundation for Cardiovascular Research, EU Horizon 2020, EU FP7. Advisory Board Member: BMS‐Pfizer‐alliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. K.E. Juhani Airaksinen: Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer Ingelheim. Member in the advisory boards: Bayer, Pfizer and AstraZeneca. Mika Lehto: Consultant: BMS‐Pfizer‐alliance, Bayer, Boehringer Ingelheim, and MSD; Speaker: BMS‐Pfizer‐alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer Ingelheim. Aapo Aro: Research grants: Finnish Foundation for Cardiovascular Research; Speaker: Abbott, Johnson&Johnson, Sanofi, Bayer, Boehringer Ingelheim. Other authors: none. Funding Information: This work was supported by the Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research and Helsinki and Uusimaa Hospital District research fund (TYH2019309). Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication Publisher Copyright: © 2022 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation. Background: Atrial fibrillation (AF) patients with mental health conditions (MHCs) have higher incidence of ischaemic stroke (IS) than patients without MHC, but whether this results from direct impact of MHCs or relates to higher prevalence of comorbidities and differences in the use of oral anticoagulant (OAC) therapy is unclear. We assessed the hypothesis that MHCs independently increase the risk of IS in patients with incident AF. Methods: The nationwide FinACAF cohort covered all 203,154 patients diagnosed with incident AF without previous IS or transient ischaemic attack in Finland during 2007–2018. MHCs of interest were depression, bipolar disorder, anxiety disorder, schizophrenia and any MHC. The outcomes were first-ever IS and all-cause death. Results: The patients' (mean age 73.0 ± 13.5 years, 49.0% female) mean follow-up time was 4.3 (SD 3.3) years and 16,272 (8.0%) experienced first-ever IS and 63,420 (31.2%) died during follow-up. After propensity score matching and adjusting for OAC use, no MHC group was associated with increased IS risk (adjusted SHRs (95% CI): depression 0.961 (0.857–1.077), bipolar disorder 1.398 (0.947–2.006), anxiety disorder 0.878 (0.718–1.034), schizophrenia 0.803 (0.594–1.085) and any MHC 1.033 (0.985–1.085)). Lower rate of OAC use partly explained the observed higher crude IS incidence in patients with any MHC. Depression, schizophrenia and any MHC were associated with higher all-cause mortality (adjusted HRs [95% CI]: 1.208 [1.136–1.283], 1.543 [1.352–1.761] and 1.149 [1.116–1.175], respectively). Conclusions: In this nationwide retrospective cohort study, MHCs were not associated with the incidence of first-ever IS in patients with AF.

Published
2022

30. Mental health conditions and use of rhythm control therapies in patients with atrial fibrillation

Author

Teppo, Konsta, Jaakkola, Jussi, Biancari, Fausto, Halminen, Olli, Putaala, Jukka, Mustonen, Pirjo, Haukka, Jari, Linna, Miika, Kinnunen, Janne, Luojus, Alex, Itäinen-Strömberg, Saga, Penttilä, Tero, Niemi, Mikko, Hartikainen, Juha, Airaksinen, Ke Juhani, Lehto, Mika, University of Turku, GVM Care & Research, Department of Industrial Engineering and Management, University of Helsinki, Turun yliopistollinen keskussairaala, Tampere University, University of Eastern Finland, Turku University Hospital, Aalto-yliopisto, and Aalto University

Subjects
cardiology, depression & mood disorders, schizophrenia & psychotic disorders, mental health, cardiac epidemiology
Abstract

Publisher Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. OBJECTIVES: Mental health conditions (MHCs) have been associated with undertreatment of unrelated medical conditions, but whether patients with MHCs face disparities in receiving rhythm control therapies for atrial fibrillation (AF) is currently unknown. We assessed the hypothesis that MHCs are associated with a lower use of antiarrhythmic therapies (AATs). DESIGN: A nationwide retrospective registry-based cohort study. SETTING: The Finnish AntiCoagulation in Atrial Fibrillation cohort included records on all patients with AF in Finland during 2007-2018 identified from nationwide registries covering all levels of care as well as drug purchases. MHCs of interest were diagnosed depression, bipolar disorder, anxiety disorder, schizophrenia and any MHC. PARTICIPANTS: We identified 239 222 patients (mean age 72.6±13.2 years; 49.8% women) with incident AF, in whom the prevalence of any MHC was 19.9%. OUTCOMES: Primary outcome was use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription. RESULTS: Lower overall use of any AAT emerged in patients with any MHC than in those without MHC (16.9% vs 22.9%, p

Published
2022

32. Association of income and educational levels with adherence to direct oral anticoagulant therapy in patients with incident atrial fibrillation

Author

Teppo, Konsta, Jaakkola, Jussi, Biancari, Fausto, Halminen, Olli, Linna, Miika, Haukka, Jari, Putaala, Jukka, Tiili, Paula, Lehtonen, Ossi, Niemi, Mikko, Mustonen, Pirjo, Kinnunen, Janne, Hartikainen, Juha, Airaksinen, K. E.Juhani, Lehto, Mika, University of Turku, University of Helsinki, Department of Industrial Engineering and Management, Dept Signal Process and Acoust, Turku University Hospital, University of Eastern Finland, Aalto-yliopisto, and Aalto University

Subjects
socioeconomic status, educational level, income, atrial fibrillation, adherence, persistence, direct oral anticoagulants
Abstract

Funding Information: Konsta Teppo: none. Jussi Jaakkola: none. Fausto Biancari: none Olli Halminen: none. Jukka Putaala: Dr. Putaala reports personal fees from Boehringer‐Ingelheim, personal fees and other from Bayer, grants and personal fees from BMS‐Pfizer, personal fees from Portola, other from Amgen, personal fees from Herantis Pharma, personal fees from Terve Media, other from Vital Signum, personal fees from Abbott, outside the submitted work. Pirjo Mustonen: Consultant: Roche, BMS‐Pfizer‐alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. Jari Haukka: Consultant: Research Janssen R&D; Speaker: Bayer Finland. Miika Linna: Speaker: BMSPfizer‐alliance, Bayer, Boehringer‐Ingelheim. Juha Hartikainen: Research grants: The Finnish Foundation for Cardiovascular Research, EU Horizon 2020, EU FP7. Advisory Board Member: BMS‐Pfizer‐alliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. K. E. Juhani Airaksinen: Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer‐Ingelheim. Member in the advisory boards: Bayer, Pfizer and AstraZeneca. Mika Lehto: Consultant: BMS‐Pfizer‐alliance, Bayer, Boehringer‐Ingelheim, and MSD; Speaker: BMS‐Pfizer‐alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer‐Ingelheim. Paula Tiili: none. Mikko Niemi: none: Ossi Lehtonen: none. Funding Information: This work was supported by the Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund (TYH2019309). /: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Role of the Funder Sponsor Publisher Copyright: © 2022 The Authors. Pharmacology Research & Perspectives published by John Wiley & Sons Ltd, British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics. Low socioeconomic status has been associated with poor outcomes in patients with atrial fibrillation (AF). However, little is known about socioeconomic disparities in adherence to stroke prevention with direct oral anticoagulants (DOACs). We assessed the hypothesis that AF patients with higher income or educational levels have better adherence to DOACs in terms of treatment implementation and persistence. The used nationwide registry-based FinACAF cohort covers all patients with incident AF starting DOACs in Finland during 2011–2018. The implementation analyses included 74 222 (mean age 72.7 ± 10.5 years, 50.8% female) patients, and persistence analyses included 67 503 (mean age 75.3 ± 8.9 years, 53.6% female) patients with indication for permanent anticoagulation (CHA2DS2-VASc score >1 in men and >2 in women). Patients were divided into income quartiles and into three categories based on their educational attainment. Therapy implementation was measured using the medication possession ratio (MPR), and patients with MPR ≥0.90 were defined adherent. Persistence was measured as the incidence of therapy discontinuation, defined as the first 135-day period without DOAC purchases after drug initiation. Patients with higher income or education were consistently more likely adherent to DOACs in the implementation phase (comparing the highest income or educational category to the lowest: adjusted odds ratios 1.18 (1.12–1.25) and 1.21 (1.15–1.27), respectively). No association with income or educational levels was observed on the incidence of therapy discontinuation. In conclusion, we observed that income and educational levels both have independent positive association on the implementation of DOAC therapy but no association on therapy persistence in patients with AF.

Published
2022

34. Mental health conditions and adherence to direct oral anticoagulants in patients with incident atrial fibrillation

Author

Teppo, Konsta, Jaakkola, Jussi, Airaksinen, K. E.Juhani, Biancari, Fausto, Halminen, Olli, Putaala, Jukka, Mustonen, Pirjo, Haukka, Jari, Hartikainen, Juha, Luojus, Alex, Niemi, Mikko, Linna, Miika, Lehto, Mika, University of Turku, University of Helsinki, Department of Industrial Engineering and Management, University of Eastern Finland, Aalto-yliopisto, and Aalto University

Subjects
Adherence, Depression, Implementation, Psychiatric disorder, Atrial fibrillation, Direct oral anticoagulant, Mental health condition
Abstract

Funding Information: This work was supported by the Aarne Koskelo Foundation , The Finnish Foundation for Cardiovascular Research , and Helsinki and Uusimaa Hospital District research fund. Funding Information: Konsta Teppo: none. Jussi Jaakkola: none. Fausto Biancari: none Olli Halminen: none. Jukka Putaala: Dr. Putaala reports personal fees from Boehringer-Ingelheim, personal fees and other from Bayer, grants and personal fees from BMS-Pfizer, personal fees from Portola, other from Amgen, personal fees from Herantis Pharma, personal fees from Terve Media, other from Vital Signum, personal fees from Abbott, outside the submitted work. Pirjo Mustonen: Consultant: Roche, BMS-Pfizer-alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. Jari Haukka: Consultant: Research Janssen R&D; Speaker: Bayer Finland. Miika Linna: Speaker: BMSPfizer-alliance, Bayer, Boehringer-Ingelheim. Alex Luojus: none. Juha Hartikainen: Research grants: The Finnish Foundation for Cardiovascular Research, EU Horizon 2020, EU FP7. Advisory Board Member: BMS-Pfizer-alliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. K.E. Juhani Airaksinen: Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer-Ingelheim. Member in the advisory boards: Bayer, Pfizer and AstraZeneca. Mika Lehto: Consultant: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, and MSD; Speaker: BMS-Pfizer-alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer-Ingelheim. Mikko Niemi: None. Publisher Copyright: © 2022 The Author(s) Objective: Medication adherence is essential for effective stroke prevention in patients with atrial fibrillation (AF). We aimed to assess whether adherence to direct oral anticoagulants (DOACs) in AF patients is affected by the presence of mental health conditions (MHCs). Methods: The nationwide FinACAF cohort covered 74,222 AF patients from all levels of care receiving DOACs during 2011–2018 in Finland. Medication possession ratio (MPR) was used to quantify adherence. Patients with MPR ≥0.90 were defined adherent. MHCs of interest were depression, bipolar disorder, anxiety disorder and schizophrenia. Results: The patients' (mean age 75.4 ± 9.5 years, 50.8% female) mean MPR was 0.84 (SD 0.22), and 59.5% had MPR ≥0.90. Compared to patients without MHC, the adjusted ORs (95% CI) for adherent DOAC use emerged slightly lower in patients with depression (0.92 (0.84–0.99)) and bipolar disorder (0.77 (0.61–0.97)) and unsignificant in patients with anxiety disorder (1.08 (0.96–1.21)) and schizophrenia (1.13 (0.90–1.43)). However, when only persistent DOAC therapy was analyzed, no MHC was associated with poor adherence, and instead anxiety disorder was associated with adherent DOAC use (1.18 (1.04–1.34)). Conclusion: Adherence to DOACs in AF patients in Finland was relatively high, and no meaningful differences between patients with and without MHCs were observed.

Published
2022

35. The nationwide Finnish anticoagulation in atrial fibrillation (FinACAF)

Author

Lehto, Mika, Halminen, Olli, Mustonen, Pirjo, Putaala, Jukka, Linna, Miika, Kinnunen, Janne, Kouki, Elis, Niiranen, Jussi, Hartikainen, Juha, Haukka, Jari, Airaksinen, Kari Eino Juhani, HUS, Department of Industrial Engineering and Management, Turku University Hospital, University of Helsinki, University of Eastern Finland, Aalto-yliopisto, and Aalto University

Subjects
Stroke, Anticoagulation, Cost-effectiveness, Atrial fibrillation, Register study
Abstract

Funding Information: Mika Lehto: Consultant: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, and MSD; Speaker: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund, Boehringer-Ingelheim. Olli Halminen: none. Pirjo Mustonen: Consultant: Roche, BMS-Pfizer-alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. Jukka Putaala: Consultant: Boehringer-Ingelheim, Bayer, BMS-Pfizer, Abbott/St. Jude Medical, Vital Signum, Nokia Technologies, Bittium, BcB Medical, Herantis Pharma, Medixine, and Portola. Speaker: Boehringer-Ingelheim, Bayer, BMS-Pfizer, and Terve Media; Research grants: BMS-Pfizer, Abbott/St. Jude Medical, Business Finland, and Amgen. Miika Linna: Speaker: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim. Janne Kinnunen: none. Jussi Niiranen: none. Elis Kouki: none. Juha Hartikainen: Research grants: The Finnish Foundation for Cardiovascular Research, Advisory Board Member: BMS-Pfizer-alliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. Jari Haukka: Consultant: Research Janssen R&D; Speaker: Bayer Finland. K.E. Juhani Airaksinen: Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer-Ingelheim. Member in the advisory boards: Bayer, Pfizer and AstraZeneca. Funding Information: Open access funding provided by University of Helsinki including Helsinki University Central Hospital. This work was supported by Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund (TYH2019309). Publisher Copyright: © 2022, The Author(s). Atrial fibrillation (AF) is a major cause of ischemic stroke and the number of AF patients is increasing. Thus, up-to-date multifaceted data about the characteristics of AF patients, their treatments, and outcomes are urgently needed. The Finnish anticoagulation in atrial fibrillation (FinACAF) study has collected comprehensive data on all Finnish AF patients from 1st January 2004 to 31st December 2018. The aim of this paper is to describe the study rationale, the process of integrating data from the applied resources and to define the study cohort. Using national unique personal identification number, individual patient data is linked from nationwide health care registries (primary, secondary, and tertiary care), drug purchases, education, and socio-economic status as well as places of domicile, incomes, and taxes. Six regional laboratory databases (~ 282,000, 77% of the patients) are also included. The study cohort comprises of a total of 411,000 patients. Since the introduction of the national primary careregister in 2012, 9% of all AF patients were identified outside hospital care registers. The prevalence of AF in Finland—4.1% of whole population—is for the first time now established. The FinACAF study allows a unique possibility to investigate the epidemiology and socio-medico-economic impact of AF as well as the cost effectiveness of different AF management strategies in a completely unselected, nationwide population. This article provides the rationale and design of the study together with a summary of the characteristics of the cohort.

Published
2022

36. Rural-urban differences in the initiation of oral anticoagulant therapy in patients with incident atrial fibrillation

Author

Teppo, Konsta, Jaakkola, Jussi, Langén, Ville L., Biancari, Fausto, Halminen, Olli, Linna, Miika, Haukka, Jari, Putaala, Jukka, Mustonen, Pirjo, Kinnunen, Janne, Luojus, Alex, Hartikainen, Juha, Airaksinen, K. E.Juhani, Lehto, Mika, University of Turku, Turku University Hospital, University of Helsinki, Department of Industrial Engineering and Management, University of Eastern Finland, Aalto-yliopisto, and Aalto University

Abstract

AIMS: Little is known about rural-urban differences in the treatment and outcomes in patients with atrial fibrillation (AF). We aimed to assess whether the initiation of oral anticoagulant (OAC) therapy in patients with AF differs between those with rural and urban residence. METHODS: The registry-based FinACAF cohort covers all patients with AF from all levels of care in Finland. Patients were divided into rural and urban categories and into urbanization degree tertiles based on their municipality of residence at the time of AF diagnosis. The outcome was the first redeemed OAC prescription. RESULTS: We identified 222 419 patients (50.1% female; mean age 72.8 (SD 13.2) years) with incident AF during 2007-2018. Urban residence was associated with a lower rate of OAC therapy initiation (adjusted subdistribution hazard ratio (SHR) (95% CI) 0.96 (0.95-0.97)). Correspondingly, an inverse graded dose-response relationship was observed between higher urbanization degree tertile and OAC initiation rate (highest tertile compared to lowest: adjusted SHR (95% CI) 0.94 (0.93-0.95)). The adoption of direct oral anticoagulants for stroke prevention was faster among patients with urban residence. CONCLUSION: This nationwide cohort study documented that urban residence is associated with a slightly lower rate of OAC therapy initiation in patients with incident AF, but faster adoption of direct oral anticoagulant use.

Published
2022

39. 4D Flow Versus 2D Phase Contrast MRI in Populations With Bi- and Tricuspid Aortic Valves.

Author

HAUTANEN, SOFIA, KILJANDER, TEEMU, KORPELA, TARMO, SAARI, PETRI, KOKKONEN, JORMA, MUSTONEN, PIRJO, SILLANMÄKI, SAARA, YLÄ-HERTTUALA, ELIAS, HUSSO, MINNA, HEDMAN, MARJA, and KAUHANEN, PETTERI

Subjects
MAGNETIC resonance imaging, AORTIC valve, MEDICAL care, MEDICAL personnel, AORTIC valve insufficiency
Abstract

Aim: To compare 4D flow magnetic resonance imaging (MRI) and 2D phase contrast (PC) MRI when evaluating bicuspid (BAV) and tricuspid (TAV) aortic valves. Materials and Methods: A total of 83 subjects (35 BAV, 48 TAV) were explored with 4D flow and 2D PC MRI. Systolic peak velocity, peak flow and regurgitation fraction were analysed at two pre-defined aortic levels (aortic root, midtubular). Furthermore, the two methods of 4D flow analysis (Heart and Artery) were compared. Results: Correlation between the 2D PC MRI and 4D flow MRI derived parameters ranged from moderate (R=0.58) to high (R=0.90). 4D flow MRI yielded significantly higher peak velocities in the tubular aorta in both groups. Regarding the aortic root, peak velocities were significantly higher in the TAV group with 4D flow MRI, but in the BAV group 4D flow MRI yielded non-significantly lower values. Findings on peak flow differences between the two modalities followed the same pattern as the differences in peak velocities. 4D flow MRI derived regurgitation fraction values were lower in both locations in both groups. Interobserver agreement for different 4D flow MRI acquired parameters varied from poor (ICC=0.07) to excellent (ICC=1.0) in the aortic root, and it was excellent in the tubular aorta (ICC=0.8-1.0). Conclusion: 4D flow MRI seems to be accurate in comparison to 2D PC MRI in normal aortic valves and in BAV with mild to moderate stenosis. However, the varying interobserver reproducibility and impaired accuracy at higher flow velocities should be taken into account in clinical practice when using the 4D flow method. [ABSTRACT FROM AUTHOR]

Published
2023
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40. Association of income and educational levels on initiation of oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study.

Author

Teppo, Konsta, Jaakkola, Jussi, Biancari, Fausto, Halminen, Olli, Linna, Miika, Haukka, Jari, Putaala, Jukka, Mustonen, Pirjo, Kinnunen, Janne, Hartikainen, Juha, Airaksinen, K. E. Juhani, and Lehto, Mika

Subjects
ORAL medication, EDUCATIONAL attainment, MEDICAL registries, ATRIAL fibrillation, EDUCATION associations, INCOME, ISCHEMIC stroke
Abstract

Aims: Socioeconomic disparities have been reported in the outcomes of patients with atrial fibrillation (AF). We assessed the hypothesis that AF patients with higher income or educational level are more frequently initiated with oral anticoagulant (OAC) therapy for stroke prevention. Methods: The nationwide registry‐based Finnish AntiCoagulation in Atrial Fibrillation cohort covers all patients with AF from all levels of care in Finland. Patients were divided into income quartiles according to their highest annual income during 2004‐2018 and into three categories based on educational attainment. The outcome was the first redeemed OAC prescription. Results: We identified 239 222 patients (mean age 72.7 ± 13.2 years, 49.8% female) with incident AF during 2007‐2018. Higher income was associated with higher OAC initiation rate: compared to the lowest income quartile the adjusted SHRs (95% CI) for OAC initiation were 1.09 (1.07‐1.10), 1.13 (1.11‐1.14) and 1.13 (1.12‐1.15) in the second, third and fourth income quartiles, respectively. Patients in the highest educational category had a slightly lower OAC initiation rate than patients in the lowest educational category (adjusted SHR 0.92 [95% CI 0.90‐0.93]). Income‐related disparities were larger and education‐related disparities only marginal among patients at high risk of ischemic stroke. The socioeconomic disparities in OAC initiation within 1‐year follow‐up decreased from 2007 to 2018. The adoption of direct OACs as the initial anticoagulant was faster among patients with higher income or educational levels. Conclusion: These findings highlight potential missed opportunities in stroke prevention, especially among AF patients with low income, whereas the education‐related disparities in OAC initiation appear controversial. [ABSTRACT FROM AUTHOR]

Published
2023
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41. Rural-urban differences in the initiation of oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study.

Author

Teppo, Konsta, Jaakkola, Jussi, Langén, Ville L., Biancari, Fausto, Halminen, Olli, Linna, Miika, Haukka, Jari, Putaala, Jukka, Mustonen, Pirjo, Kinnunen, Janne, Luojus, Alex, Hartikainen, Juha, Airaksinen, K. E. Juhani, and Lehto, Mika

Subjects
ATRIAL fibrillation, ORAL medication, RURAL-urban differences, COHORT analysis
Abstract

Aims: Little is known about rural-urban differences in the treatment and outcomes in patients with atrial fibrillation (AF). We aimed to assess whether the initiation of oral anticoagulant (OAC) therapy in patients with AF differs between those with rural and urban residence. Methods: The registry-based FinACAF cohort covers all patients with AF from all levels of care in Finland. Patients were divided into rural and urban categories and into urbanization degree tertiles based on their municipality of residence at the time of AF diagnosis. The outcome was the first redeemed OAC prescription. Results: We identified 222 419 patients (50.1% female; mean age 72.8 (SD 13.2) years) with incident AF during 2007–2018. Urban residence was associated with a lower rate of OAC therapy initiation (adjusted subdistribution hazard ratio (SHR) (95% CI) 0.96 (0.95–0.97)). Correspondingly, an inverse graded dose-response relationship was observed between higher urbanization degree tertile and OAC initiation rate (highest tertile compared to lowest: adjusted SHR (95% CI) 0.94 (0.93–0.95)). The adoption of direct oral anticoagulants for stroke prevention was faster among patients with urban residence. Conclusion: This nationwide cohort study documented that urban residence is associated with a slightly lower rate of OAC therapy initiation in patients with incident AF, but faster adoption of direct oral anticoagulant use. [ABSTRACT FROM AUTHOR]

Published
2022
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43. European National Society Cardiovascular Journals. Background, Rationale, and Mission Statement of the “Editors' Club”

Author

Alfonso, Fernando, Ambrosio, Giuseppe, Pinto, Fausto J., van der Wall, Ernst E., Kondili, Anesti, Nibouche, Djamaleddine, Adamyan, Karlen, Huber, Kurt, Ector, Hugo, Masic, Izet, Tarnovska, Rumiana, Ivanusa, Mario, Staněk, Vladimír, Videbæk, Jørgen, Hamed, Mohamed, Laucevicius, Alexandras, Mustonen, Pirjo, Artigou, Jean-Yves, Cohen, Ariel, Rogava, Mamanti, Böhm, Michael, Fleck, Eckart, Heusch, Gerd, Klawki, Rainer, Vardas, Panos, Stefanadis, Christodoulos, Tenczer, József, Chiariello, Massimo, Elias, Joseph, Benjelloun, Halima, Rødevand, Olaf, Kulakowski, Piotr, Apetrei, Edvard, Lusov, Victor A., Oganov, Rafael G., Obradovic, Velibor, Kamensky, Gabriel, Kenda, Miran F., Höglund, Christer, Lüscher, Thomas F., Lerch, René, Jokhadar, Moufid, Haouala, Habib, Sansoy, Vedat, Shumakov, Valentin, and Timmis, Adam

Published
2008
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45. Mental health conditions and risk of first‐ever ischaemic stroke and death in patients with incident atrial fibrillation: A nationwide cohort study.

Author

Teppo, Konsta, Jaakkola, Jussi, Biancari, Fausto, Halminen, Olli, Putaala, Jukka, Mustonen, Pirjo, Haukka, Jari, Linna, Miika, Kinnunen, Janne, Tiili, Paula, Kouki, Elis, Penttilä, Tero, Hartikainen, Juha, Aro, Aapo L., Airaksinen, K. E. Juhani, and Lehto, Mika

Subjects
ISCHEMIC stroke, ATRIAL fibrillation, STROKE patients, MENTAL health, ANXIETY disorders, TRANSIENT ischemic attack, COHORT analysis
Abstract

Background: Atrial fibrillation (AF) patients with mental health conditions (MHCs) have higher incidence of ischaemic stroke (IS) than patients without MHC, but whether this results from direct impact of MHCs or relates to higher prevalence of comorbidities and differences in the use of oral anticoagulant (OAC) therapy is unclear. We assessed the hypothesis that MHCs independently increase the risk of IS in patients with incident AF. Methods: The nationwide FinACAF cohort covered all 203,154 patients diagnosed with incident AF without previous IS or transient ischaemic attack in Finland during 2007–2018. MHCs of interest were depression, bipolar disorder, anxiety disorder, schizophrenia and any MHC. The outcomes were first‐ever IS and all‐cause death. Results: The patients' (mean age 73.0 ± 13.5 years, 49.0% female) mean follow‐up time was 4.3 (SD 3.3) years and 16,272 (8.0%) experienced first‐ever IS and 63,420 (31.2%) died during follow‐up. After propensity score matching and adjusting for OAC use, no MHC group was associated with increased IS risk (adjusted SHRs (95% CI): depression 0.961 (0.857–1.077), bipolar disorder 1.398 (0.947–2.006), anxiety disorder 0.878 (0.718–1.034), schizophrenia 0.803 (0.594–1.085) and any MHC 1.033 (0.985–1.085)). Lower rate of OAC use partly explained the observed higher crude IS incidence in patients with any MHC. Depression, schizophrenia and any MHC were associated with higher all‐cause mortality (adjusted HRs [95% CI]: 1.208 [1.136–1.283], 1.543 [1.352–1.761] and 1.149 [1.116–1.175], respectively). Conclusions: In this nationwide retrospective cohort study, MHCs were not associated with the incidence of first‐ever IS in patients with AF. [ABSTRACT FROM AUTHOR]

Published
2022
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46. Income and outcomes of patients with incident atrial fibrillation.

Author

Biancari, Fausto, Teppo, Konsta, Jaakkola, Jussi, Halminen, Olli, Linna, Miika, Haukka, Jari, Putaala, Jukka, Mustonen, Pirjo, Kinnunen, Janne, Hartikainen, Juha, Aro, Aapo, Airaksinen, Juhani, and Lehto, Mika

Subjects
KRUSKAL-Wallis Test, SCIENTIFIC observation, CONFIDENCE intervals, ECONOMIC status, ISCHEMIC stroke, MULTIVARIATE analysis, ATRIAL fibrillation, DISEASE incidence, INCOME, RISK assessment, DESCRIPTIVE statistics, SOCIAL classes, CHI-squared test, KAPLAN-Meier estimator, DATA analysis software, PROPORTIONAL hazards models, DISEASE risk factors, DISEASE complications
Published
2022
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48. an international multicentre single-arm clinical trial

Author

Barco, Stefano, Schmidtmann, Irene, Ageno, Walter, Bauersachs, Rupert M., Becattini, Cecilia, Bernardi, Enrico, Beyer-Westendorf, Jan, Bonacchini, Luca, Brachmann, Johannes, Christ, Michael, Czihal, Michael, Duerschmied, Daniel, Empen, Klaus, Espinola-Klein, Christine, Ficker, Joachim H., Fonseca, Cândida, Genth-Zotz, Sabine, Jiménez, David, Harjola, Veli Pekka, Held, Matthias, Iogna Prat, Lorenzo, Lange, Tobias J., Manolis, Athanasios, Meyer, Andreas, Mustonen, Pirjo, Rauch-Kroehnert, Ursula, Ruiz-Artacho, Pedro, Schellong, Sebastian, Schwaiblmair, Martin, Stahrenberg, Raoul, Westerweel, Peter E., Wild, Philipp S., Konstantinides, Stavros V., Lankeit, Mareike, and NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)

Subjects
Rivaroxaban, SDG 3 - Good Health and Well-being, Pulmonary embolism, Home treatment, Management trial, Right ventricular dysfunction, Cardiology and Cardiovascular Medicine, Risk stratification
Abstract

Funding: HoT-PE is an independent, investigator-initiated trial with an academic sponsor (Centre for Thrombosis and Haemostasis, University Medical Centre Mainz, Germany). The work of Stefano Barco, Philipp S. Wild, Stavros V. Konstantinides, and Mareike Lankeit was supported by the German Federal Ministry of Education and Research [BMBF 01EO1003 and 01EO1503]. In addition, the sponsor has obtained the study drug (rivaroxaban) and a grant from the market authorization holder of rivaroxaban, Bayer AG. AIMS: To investigate the efficacy and safety of early transition from hospital to ambulatory treatment in low-risk acute PE, using the oral factor Xa inhibitor rivaroxaban. METHODS AND RESULTS: We conducted a prospective multicentre single-arm investigator initiated and academically sponsored management trial in patients with acute low-risk PE (EudraCT Identifier 2013-001657-28). Eligibility criteria included absence of (i) haemodynamic instability, (ii) right ventricular dysfunction or intracardiac thrombi, and (iii) serious comorbidities. Up to two nights of hospital stay were permitted. Rivaroxaban was given at the approved dose for PE for ≥3 months. The primary outcome was symptomatic recurrent venous thromboembolism (VTE) or PE-related death within 3 months of enrolment. An interim analysis was planned after the first 525 patients, with prespecified early termination of the study if the null hypothesis could be rejected at the level of α = 0.004 (

Published
2020

49. Association of income and educational levels with adherence to direct oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study .

Author

Teppo, Konsta, Jaakkola, Jussi, Biancari, Fausto, Halminen, Olli, Linna, Miika, Haukka, Jari, Putaala, Jukka, Tiili, Paula, Lehtonen, Ossi, Niemi, Mikko, Mustonen, Pirjo, Kinnunen, Janne, Hartikainen, Juha, Juhani Airaksinen, K. E., and Lehto, Mika

Subjects
ORAL medication, EDUCATIONAL attainment, ATRIAL fibrillation, EDUCATION associations, COHORT analysis, ANTICOAGULANTS
Abstract

Low socioeconomic status has been associated with poor outcomes in patients with atrial fibrillation (AF). However, little is known about socioeconomic disparities in adherence to stroke prevention with direct oral anticoagulants (DOACs). We assessed the hypothesis that AF patients with higher income or educational levels have better adherence to DOACs in terms of treatment implementation and persistence. The used nationwide registry-based FinACAF cohort covers all patients with incident AF starting DOACs in Finland during 2011–2018. The implementation analyses included 74 222 (mean age 72.7 ± 10.5 years, 50.8% female) patients, and persistence analyses included 67 503 (mean age 75.3 ± 8.9 years, 53.6% female) patients with indication for permanent anticoagulation (CHA2DS2-VASc score >1 in men and >2 in women). Patients were divided into income quartiles and into three categories based on their educational attainment. Therapy implementation was measured using the medication possession ratio (MPR), and patients with MPR ≥0.90 were defined adherent. Persistence was measured as the incidence of therapy discontinuation, defined as the first 135-day period without DOAC purchases after drug initiation. Patients with higher income or education were consistently more likely adherent to DOACs in the implementation phase (comparing the highest income or educational category to the lowest: adjusted odds ratios 1.18 (1.12–1.25) and 1.21 (1.15–1.27), respectively). No association with income or educational levels was observed on the incidence of therapy discontinuation. In conclusion, we observed that income and educational levels both have independent positive association on the implementation of DOAC therapy but no association on therapy persistence in patients with AF. [ABSTRACT FROM AUTHOR]

Published
2022
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