Förmaksflimmer - människans näst bästa rytm

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Real-life experience with non-vitamin K antagonist oral anticoagulants versus warfarin in patients undergoing elective cardioversion of atrial fibrillation

Background Nonvitamin K antagonist oral anticoagulants (NOACs) are increasingly used in patients with atrial fibrillation (AF) undergoing elective cardioversion (ECV). The aim was to investigate the use of NOACs and warfarin in ECV in a real-life setting and to assess how the chosen regimen affected the delay to ECV and rate of complications. Methods Consecutive AF patients undergoing ECVs in the city hospitals of Helsinki between January 2015 and December 2016 were studied. Data on patient characteristics, delays to cardioversion, anticoagulation treatment, acute ( Results Nine hundred patients (59.2% men; mean age, 68.0 +/- 10.0) underwent 992 ECVs, of which 596 (60.0%) were performed using NOACs and 396 (40.0%) using warfarin. The mean CHA(2)DS(2)-VASc score was 2.5 (+/- 1.6). In patients without previous anticoagulation treatment, NOACs were associated with a shorter mean time to cardioversion than warfarin (51 versus. 68 days, respectively; p <.001). Six thromboembolic events (0.6%) occurred: 4 (0.7%) in NOAC-treated patients and 2 (0.5%) in warfarin-treated patients. Clinically relevant bleeding events occurred in seven patients (1.8%) receiving warfarin and three patients (0.5%) receiving NOACs. Anticoagulation treatment was altered for 99 patients (11.0%) during the study period, with the majority (88.2%) of changes from warfarin to NOACs. Conclusions In this real-life study, the rates of thromboembolic and bleeding complications were low in AF patients undergoing ECV. Patients receiving NOAC therapy had a shorter time to cardioversion and continued their anticoagulation therapy more often than patients on warfarin.Peer reviewe

Comprehensive nationwide incidence and prevalence trends of atrial fibrillation in Finland

Peer reviewe

Socioeconomic disparities in use of rhythm control therapies in patients with incident atrial fibrillation : A Finnish nationwide cohort study

Background: In patients with atrial fibrillation (AF), socioeconomic disparities have been reported in the use of oral anticoagulant therapy and outcomes, but whether income also affects the utilization of antiarrhythmic therapies (AATs) for rhythm control is unknown. We assessed the hypothesis that AF patients with higher income are more likely to receive AATs.Methods: The nationwide retrospective registry based FinACAF cohort study covers all patients with AF from all levels of care in Finland. Patients were divided in AF diagnosis year and age-group specific income quintiles according to their highest annual income during 2004-2018. The primary outcome was the use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription.Results: We identified 188 175 patients (mean age 72.6 +/- 13.0 years; 49.6% female) with incident AF during 2010-2018. Patients in higher income quintiles had consistently higher use of all AAT modalities. When compared to patients in the lowest income quintile, the adjusted incidence rate ratios (95% CI) in the highest quintile were 1.53 (1.48-1.59) for any AAT, 1.71 (1.61-1.81) for AADs, 1.43 (1.37-1.49) for cardioversion, and 2.00 (1.76-2.27) for catheter ablation. No temporal change during study period was observed in the magnitude of income disparities in AAT use, except for a decrease in income-related differences in the use of AADs.Conclusion: Profound income-related disparities exist in AAT use among patients with AF in Finland, especially in the use catheter ablation.Peer reviewe

Rural–Urban differences in Use of Rhythm Control Therapies in Patients with Incident Atrial Fibrillation: A Finnish Nationwide Cohort Study

Background: Rural–urban disparities have been reported in the access, utilization, and quality of healthcare. We aimed to assess whether use of antiarrhythmic therapies (AATs) in patients with atrial fibrillation (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 primary outcome was the use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription. Results: We identified 177,529 patients (49.9% female, mean age 73.0 (SD13.0) years) with incident AF during 2010–2018. Except for AADs, the differences in AAT use were nonsignificant when patients were stratified according to the rural–urban classification system (urban vs. rural adjusted incidence rate ratios (aIRRs) with 95% CIs for any AAT 1.01 (0.99–1.03), AADs 1.11 (1.07–1.15), cardioversion 1.01 (0.98–1.03), catheter ablation 1.05 (0.98–1.12)). However, slightly higher use of all rhythm control modalities was observed in the highest urbanization degree tertile when compared to the lowest tertile (aIRRs with 95% Cis for any AAT 1.06 (1.03–1.08), AADs 1.18 (1.14–1.23), cardioversion 1.05 (1.02–1.08), catheter ablation 1.10 (1.02–1.19)). Conclusions: This nationwide retrospective cohort study observed that urban residence is associated with higher use of AADs in patients with incident AF. Otherwise, the observed disparities were only marginal, suggesting that in the use of rhythm control therapies, no large rural–urban inequity exists in Finland

Mental health conditions and use of rhythm control therapies in patients with atrial fibrillation : a nationwide cohort study

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 Conclusions Among patients with AF, a clear disparity exists in AAT use between those with and without MHCs.Peer reviewe

Mental health conditions and use of rhythm control therapies in patients with atrial fibrillation: a nationwide cohort study

OBJECTIVESMental 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).DESIGNA nationwide retrospective registry-based cohort study.SETTINGThe 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.PARTICIPANTSWe 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%.OUTCOMESPrimary outcome was use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription.RESULTSLower overall use of any AAT emerged in patients with any MHC than in those without MHC (16.9% vs 22.9%, pCONCLUSIONSAmong patients with AF, a clear disparity exists in AAT use between those with and without MHCs.TRIAL REGISTRATION NUMBERClinicalTrials Identifier: NCT04645537; ENCePP Identifier: EUPAS29845.</p

Rural-Urban differences in Use of Rhythm Control Therapies in Patients with Incident Atrial Fibrillation: A Finnish Nationwide Cohort Study

Background: Rural-urban disparities have been reported in the access, utilization, and quality of healthcare. We aimed to assess whether use of antiarrhythmic therapies (AATs) in patients with atrial fibrillation (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 primary outcome was the use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription. Results: We identified 177,529 patients (49.9% female, mean age 73.0 (SD13.0) years) with incident AF during 2010-2018. Except for AADs, the differences in AAT use were nonsignificant when patients were stratified according to the rural-urban classification system (urban vs. rural adjusted incidence rate ratios (aIRRs) with 95% CIs for any AAT 1.01 (0.99-1.03), AADs 1.11 (1.07-1.15), cardioversion 1.01 (0.98-1.03), catheter ablation 1.05 (0.98-1.12)). However, slightly higher use of all rhythm control modalities was observed in the highest urbanization degree tertile when compared to the lowest tertile (aIRRs with 95% Cis for any AAT 1.06 (1.03-1.08), AADs 1.18 (1.14-1.23), cardioversion 1.05 (1.02-1.08), catheter ablation 1.10 (1.02-1.19)). Conclusions: This nationwide retrospective cohort study observed that urban residence is associated with higher use of AADs in patients with incident AF. Otherwise, the observed disparities were only marginal, suggesting that in the use of rhythm control therapies, no large rural-urban inequity exists in Finland.</p

Eteisvärinäpotilaan liitännäissairaudet rekisteritiedon perusteella

Lähtökohdat : Eteisvärinä on merkittävä aivoinfarktin riskitekijä, ja eteisvärinäpotilaan aivoinfarktiriskiin vaikuttavat muun muassa potilaan ikä, sukupuoli ja liitännäissairaudet. Aivoinfarktin riski arvioidaan CHA 2 DS 2 -VASc-pisteytyksen avulla, ja ≥ 2 pistettä saaneella potilaalla riski on suuri. Liitännäissairauksien asianmukainen kirjaaminen potilastietojärjestelmiin sekä terveydenhuollon rekistereihin on tärkeää. Menetelmät : Eteisvärinän aivoinfarktiriskiin vaikuttavien liitännäissairauksien esiintyvyydet ­kerättiin valtakunnallisista terveydenhuollon rekistereistä vuosina 2012–2018 uuden ­eteisvärinädiagnoosin saaneista potilaista (n = 168 356). Tulokset : Verenpainetaudin, hyperkolesterolemian ja diabeteksen suurimmat esiintyvyydet löytyivät lääkeostorekisterin perusteella. Sydämen vajaatoiminta-, valtimosairaus- sekä ­iskeeminen aivohalvaus- ja ohimenevä aivoverenkiertohäiriö (TIA) -diagnooseja tunnistettiin selvästi eniten erikoissairaanhoidon hoitoilmoitusrekisteritiedoista. CHA 2 DS 2 -VASc-arvo ≥ 2 oli miehistä 74,8 %:lla ja naisista 87,1 %:lla. Päätelmät : Kattava analyysi eteisvärinäpotilaiden liitännäissairauksista edellyttää tietojen ­laajamittaista yhdistämistä useista rekisterilähteistä.publishedVersionPeer reviewe