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

Teppo, Konsta; Jaakkola, Jussi; Biancari, Fausto; Halminen, Olli; Linna, Miika; Haukka, Jari; Putaala, Jukka; Mustonen, Pirjo; Kinnunen, Janne; Luojus, Alex; Itainen-Stromberg, S; Hartikainen, Juha; Aro, Aapo L.; Airaksinen, K. E. Juhani; Lehto, Mika

doi:10.1016/j.ijcha.2022.101070

Cited by 7 publications

(5 citation statements)

References 25 publications

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“… 60 A nationwide study in 188 175 patients with AF from Finland reported lower use of rhythm control procedures including cardioversions, use of antiarrhythmic drugs, and ablations in those with the lowest incomes. 61 A study in 2 236 580 patients with AF from the UK reported that individuals from minoritized racial and low SES groups underwent fewer catheter ablations for AF. 62 …”

Section: Resultsmentioning

confidence: 99%

Social drivers in atrial fibrillation occurrence, screening, treatment, and outcomes: systematic-narrative hybrid review

Frost,

Johnsen,

Benjamin

et al. 2024

European Heart Journal Supplements

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The importance of social drivers of health (SDOH) in the occurrence, detection, treatment, and outcome of atrial fibrillation (AF) has attracted increasing attention. Addressing SDOH factors may suggest opportunities to prevent AF and its complications. We aimed to conduct a structured narrative review and summarize current knowledge on the association between race and ethnicity, SDOH, including rural vs. urban habitation, education, income, and neighbourhood, and the risk of AF, its management, and complications. We identified 537 references in PubMed and 473 references in Embase. After removal of duplicates, we screened the abstracts of 975 references, resulting in 113 references that were examined for eligibility. Subsequently, 34 references were excluded leaving 79 references for the review. Evidence of a social gradient in AF incidence and prevelance were conflicting. However, we found substantial evidence indicating social inequities in the detection of AF, access to treatment, and outcomes such as healthcare utilization, bleeding, heart failure, stroke, dementia, work disability, and death. Inequities are reported across various health care systems and constitute a global problem affecting several continents, although data from Africa and South America are lacking. Given the documented social inequities in AF detection, management, and outcomes, there is an urgent need for healthcare systems, policymakers, and society to identify and implement effective interventions that can reduce inequities and improve outcomes in individuals with AF.

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Section: Resultsmentioning

confidence: 99%

Social drivers in atrial fibrillation occurrence, screening, treatment, and outcomes: systematic-narrative hybrid review

Frost,

Johnsen,

Benjamin

et al. 2024

European Heart Journal Supplements

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“…Finally, the higher prevalence of cardiovascular comorbidities and lower income in rural areas likely impact the clinical decision making of AATs, although these factors were controlled for in our adjusted analyses. Indeed, low income has been previously associated with lower use of rhythm control therapies [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

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

Teppo

Jaakkola

Biancari

et al. 2022

IJERPH

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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.

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“…Exclusion criteria encompassed permanent emigration abroad before 31 December 2018, and age below 20 years at AF diagnosis. The present sub‐study was conducted within a cohort of patients with incident AF from 2007 to 2018, established in previous studies of the FinACAF cohort 25,27,28 . Follow‐up started from the initial AF diagnosis and continued until the initiation of OAC therapy, death or 31 December 2018, whichever came first.…”

Section: Methodsmentioning

confidence: 99%

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

Teppo,

Airaksinen,

Jaakkola

et al. 2023

Eur J Clin Investigation

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AimsTo 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.MethodsThe 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.ResultsWe 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.ConclusionThis 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.

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

Cited by 7 publications

References 25 publications

Social drivers in atrial fibrillation occurrence, screening, treatment, and outcomes: systematic-narrative hybrid review

Social drivers in atrial fibrillation occurrence, screening, treatment, and outcomes: systematic-narrative hybrid review

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

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

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