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

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Volume Title

A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä

Date

2023-08

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Language

en

Pages

11
168-178

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Basic and Clinical Pharmacology and Toxicology, Volume 133, issue 2

Abstract

Aim: To examine international 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.

Description

Funding Information: This work was supported by Bristol Myers Squibb and Pfizer through a grant from the ERISTA programme. Publisher Copyright: © 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).

Keywords

atrial fibrillation, mortality, oral anticoagulation, stroke, variation

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Citation

Vinter, N, Halminen, O, Lehto, M, Airaksinen, K E J, Andersson, T, Wändell, P, Holzmann, M, Rutherford, O C, Halvorsen, S, Cordsen, P, Frost, L & Johnsen, S P 2023, ' Geographical variation in persistence to oral anticoagulation therapy and clinical outcomes among patients with atrial fibrillation initiating therapy in Denmark, Sweden, Norway and Finland ', Basic and Clinical Pharmacology and Toxicology, vol. 133, no. 2, pp. 168-178 . https://doi.org/10.1111/bcpt.13902