Geographical variation in persistence to oral anticoagulation therapy and clinical outcomes among patients with atrial fibrillation initiating therapy in Denmark, Sweden, Norway and Finland.

Autor: Vinter N; Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark; and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.; Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark., Halminen O; Department of Industrial Engineering and Management, Aalto University, Espoo, Finland., Lehto M; Lohja Hospital, Department of Internal Medicine, Helsinki and Uusimaa Hospital District, Lohja, Finland; Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland., Airaksinen KEJ; Turku University Hospital and University of Turku, Turku, Finland., Andersson T; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden., Wändell P; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden., Holzmann M; Functional Area of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.; Department of Internal Medicine Solna, Karolinska Institutet, Stockholm, Sweden., Rutherford OC; Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway., Halvorsen S; Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.; University of Oslo, Oslo, Norway., Cordsen P; Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark., Frost L; Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark; and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Johnsen SP; Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark.
Jazyk: angličtina
Zdroj: Basic & clinical pharmacology & toxicology [Basic Clin Pharmacol Toxicol] 2023 Aug; Vol. 133 (2), pp. 168-178. Date of Electronic Publication: 2023 Jun 04.
DOI: 10.1111/bcpt.13902
Abstrakt: Aim: To examine inter-national and regional variations in persistence of oral anticoagulation (OAC) therapy and incidence of clinical outcomes and mortality, among patients with incident atrial fibrillation (AF) in the Nordic countries.
Methods: We conducted a registry-based multinational cohort study of OAC-naïve patients diagnosed with AF that redeemed at least one prescription of OAC after AF in Denmark (N = 25 585), Sweden (N = 59 455), Norway (N = 40 046) and Finland (N = 22 415). Persistence was dispensing at least one prescription of OAC from Day 365 after the first prescription and 90 days forward.
Results: Persistence was 73.6% (95% confidence interval 73.0-74.1) in Denmark, 71.1% (70.7-71.4) in Sweden, 89.3% (88.2-90.1) in Norway and 68.6% (68.0-69.3) in Finland. One-year risk of ischemic stroke varied between 2.0% (1.8-2.1) in Norway and 1.5% (1.4-1.6) in Sweden and 1.5% (1.3-1.6) in Finland. One-year risk of major bleeding other than intracranial bleeding varied between 2.1% (1.9-2.2) in Norway and 5.9% (5.6-6.2) in Denmark. One-year mortality risk varied between 9.3% (8.9-9.6) in Denmark and 4.2% (4.0-4.4) in Norway.
Conclusion: In OAC-naïve patients with incident AF, persistence of OAC therapy and clinical outcomes vary across Denmark, Sweden, Norway and Finland. Initiation of real-time efforts are warranted to ensure uniform high-quality care across nations and regions.
(© 2023 The Authors. Basic & Clinical Pharmacology & Toxicology published by John Wiley & Sons Ltd on behalf of Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).)
Databáze: MEDLINE
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