The nationwide Finnish anticoagulation in atrial fibrillation (FinACAF) : study rationale, design, and patient characteristics

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 (similar to 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 care register 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.Peer reviewe

Comprehensive nationwide incidence and prevalence trends of atrial fibrillation in Finland

Peer reviewe

Mental health conditions and risk of first-ever ischaemic stroke and death in patients with incident atrial fibrillation : A nationwide cohort study

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.Peer reviewe

The nationwide Finnish anticoagulation in atrial fibrillation (FinACAF): study rationale, design, and patient characteristics

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 (similar to 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 care register 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.</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

Mental health conditions and risk of first-ever ischaemic stroke and death in patients with incident atrial fibrillation: A nationwide cohort study

BackgroundAtrial 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.MethodsThe 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.ResultsThe 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).ConclusionsIn this nationwide retrospective cohort study, MHCs were not associated with the incidence of first-ever IS in patients with AF.</p

Estimating the prevalence of comorbidities affecting the risk of stroke in patients with atrial fibrillation – A registry-based study

Lähtökohdat Eteisvärinä on merkittävä aivoinfarktin riskitekijä, ja eteisvärinäpotilaan aivoinfarktiriskiin vaikuttavat muun muassa potilaan ikä, sukupuoli ja liitännäissairaudet. Aivoinfarktin riski arvioidaan CHA2DS2-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. CHA2DS2-VASc-arvo ≥ 2 oli miehistä 74,8 %:lla ja naisista 87,1 %:lla. Päätelmät Kattava analyysi eteisvärinäpotilaiden liitännäissairauksista edellyttää tietojen laajamittaista yhdistämistä useista rekisterilähteistä.Bakgrund Patienter med förmaksflimmer lider av en förhöjd risk för iskemisk stroke. Faktorer som påverkar denna risk är bl.a. patientens ålder, kön och komorbiditeter. Risken för stroke bedöms mha. den kliniska CHA2DS2- VASc poängsättningen, där patienter med ≥ 2 poäng anses vara i hög risk och ofta vårdas med antikoagulantia. Komorbiditeternas adekvata och heltäckande registrering i patientsystem samt hälsovårdens register är viktigt. Metod och material Prevalensen på komorbiditeter som påverkar strokerisken i förmaksflimmer samlades från finska hälsovårdsregister av patienter med en ny diagnos på förmaksflimmer mellan 2012-2018 (n = 168 356). Centrala resultat De största prevalenserna av hypertoni, hyperkolesterolemi samt diabetes mellitus kunde hittas på basis av FPA:s register för läkemedelsinköp. Den klara majoriteten av hjärtsvikt-, vaskulär sjukdom- samt iskemisk stroke- och TIA -diagnoser identifierades på basis av specialsjukvårdens vårdanmälningssystem (HILMO). CHA2DS2-VASc riskpoängen var ≥ 2 hos 74,8 % av män och 87,1 % av kvinnor. Slutsatser En omfattande analys av komorbiditeter hos patienter med förmaksflimmer kräver vidsträckt insamling av data samt sammanslagning av information från flera olika källor

Trends and burden of diabetes in patients with atrial fibrillation during 2007-2018 : A Finnish nationwide cohort study

Aims: We assessed the temporal trends in the prevalence of diabetes and in its associations with outcomes among patients with atrial fibrillation (AF). Methods: The registry-based FinACAF study covered all patients with incident AF in Finland between 2007 and 2018. Ischemic stroke (IS) and mortality rates were computed using Poisson regression model. Results: We identified 229 565 patients (50.0% female; mean age 72.7 years; mean follow-up 4.0 years) patients with incident AF. The prevalence of diabetes increased steadily from 15.5% in 2007 to 26.3% in 2018. A decrease in IS and mortality rates was observed during the study period both in patients with and without diabetes. Diabetes was associated with IS and mortality (adjusted incidence rate ratios with 95% confidence intervals 1.22 (1.17-1.26) and 1.32 (1.29-1.34), respectively). The impact of diabetes on IS risk remained stable, while its effect on mortality increased slightly during the observation period. Conclusions: The prevalence of diabetes has increased considerably among patients with AF between 2007 and 2018. There have been substantial improvements in the prognosis of AF patients with diabetes. However, diabetes remains a significant risk factor for IS and mortality in this patient population.Peer reviewe

Temporal trends of gender disparities in oral anticoagulant use in patients with atrial fibrillation

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.Peer reviewe