Oral Anticoagulant Therapy and Risk of Admission to Long-Term Care in patients With Atrial Fibrillation: A Nationwide Cohort Study.

Autor:	Teppo K; Heart Centre, Turku University Hospital and University of Turku, Turku, Finland. Electronic address: jkitep@utu.fi., Airaksinen KEJ; Heart Centre, Turku University Hospital and University of Turku, Turku, Finland., Halminen O; Department of Industrial Engineering and Management, Aalto University, Espoo, Finland., Linna M; Department of Industrial Engineering and Management, Aalto University, Espoo, Finland; University of Eastern Finland, Kuopio, Finland., Jaakkola J; Heart Centre, Turku University Hospital and University of Turku, Turku, Finland., Haukka J; University of Helsinki, Helsinki, Finland., Putaala J; Neurology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland., Mustonen P; Heart Centre, Turku University Hospital and University of Turku, Turku, Finland., Langén VL; Department of Medicine, Turku University Hospital, Turku, Finland., Kinnunen J; Neurology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland., Hartikainen J; University of Eastern Finland, Kuopio, Finland; Heart Centre, Kuopio University Hospital, Kuopio, Finland., Lehto M; Heart and Lung Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Internal Medicine, Jorvi Hospital, Helsinki and Uusimaa Hospital District, Espoo, Finland.
Jazyk:	angličtina
Zdroj:	Journal of the American Medical Directors Association [J Am Med Dir Assoc] 2023 Oct; Vol. 24 (10), pp. 1484-1489. Date of Electronic Publication: 2023 Jun 19.
DOI:	10.1016/j.jamda.2023.05.016
Abstrakt:	Objectives: The impact of oral anticoagulants (OACs) on the need of long-term care (LTC) in the aging and multimorbid population of patients with atrial fibrillation (AF) is unknown. We conducted a nationwide cohort study to evaluate the effect of OACs on the need of LTC. Design: Retrospective nationwide cohort study. Setting and Participants: The registry-based FinACAF cohort study covers all patients with incident AF from all levels of care in Finland from 2007 to 2018, as well as all their OAC purchases, LTC admissions, and information on previous home care acuity. Methods: Incidence rate ratios (IRRs) of LTC admission were calculated using Poisson regression models with a Lexis-type data structure based on 3 time scales: follow-up time from AF diagnosis, calendar year, and age. Results: We identified 188,752 patients (49.0% female; mean age 71.4 years; mean follow-up 3.6 years) with incident AF without prior LTC, of whom 143,534 (76.0 %) initiated OAC therapy and 11,775 (6.2 %) were admitted to LTC. OAC therapy was associated with lower rates of LTC admission (adjusted IRR 0.79, 95% CI 0.76-0.82). When compared to warfarin, direct oral anticoagulants (DOACs) were associated with lower LTC admission rate (adjusted IRR 0.69, 95% CI 0.61-0.79). No significant disparities were observed between different DOACs. Conclusions and Implications: OAC therapy, particularly with DOACs, is associated with a substantially lower risk of admission to LTC in patients with AF. Increasing guideline-based OAC coverage among patients with AF may prevent the need of LTC, lengthen survival at home, and potentially decrease health care costs. (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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