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

Abstract

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 (~ 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.

Association of income and educational levels with adherence to direct oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study

“…The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) Study (ClinicalTrials Identifier: NCT04645537; ENCePP Identifier: EUPAS29845) is a retrospective nationwide cohort study covering all patients with diagnosed AF in Finland during 2004–2018. 21 Patients were identified from all available national health care registers (hospitalizations and outpatient specialist visits: HILMO; primary health care: AvoHILMO; and National Reimbursement Register upheld by Social Insurance Institute: KELA). The inclusion criterion for the cohort was an International Classification of Diseases, Tenth Revision (ICD‐10) diagnosis code I48 (including atrial fibrillation and atrial flutter, together referred as AF) recorded between 2004 and 2018 and FinACAF cohort entry occurred at the date of the first recorded AF diagnosis.…”

“…The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) Study (ClinicalTrials Identifier: NCT04645537; ENCePP Identifier: EUPAS29845) is a retrospective nationwide cohort study covering all patients with diagnosed AF in Finland during 2004–2018 21 . Patients were identified from all available national health care registers (hospitalizations and outpatient specialist visits: HILMO; primary health care: AvoHILMO; and National Reimbursement Register upheld by Social Insurance Institute: KELA).…”

“…The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) Study (ClinicalTrials Identifier: NCT04645537; ENCePP Identifier: EUPAS29845) is a retrospective nationwide cohort study covering all patients with diagnosed AF in Finland during 2004-2018. 21 Patients were identified from all available national health care registers (hospitalizations and outpatient specialist visits: HILMO; primary health care: AvoHILMO; and National Reimbursement Register 22,23 Patients not receiving DOACs during 2011-2018, when DOACs have been approved for stroke prevention in patients with AF, were excluded. Thereafter, we established two separate study cohorts for the analyses of implementation and persistence.…”

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

“…The FinACAF Study (Finnish AntiCoagulation in Atrial Fibrillation) (ClinicalTrials Identifier: NCT04645537; ENCePP Identifier: EUPAS29845) is a retrospective nationwide registry-based cohort study including all patients with an AF diagnosis in Finland during 2004–2018 [4] . Patients were identified from three national health care registers (hospitalizations and outpatient specialist visits: HILMO; primary health care: AvoHILMO; and National Reimbursement Register upheld by Social Insurance Institute: KELA).…”

“…Atrial fibrillation (AF) is the most common cardiac arrhythmia with a prevalence as high 4.1%, and it is associated with substantial mortality and morbidity, including ischemic stroke, dementia, and heart failure [1] , [2] , [3] , [4] . AF symptoms range from none to disabling, often impairing daily life with exercise intolerance and arrhythmia-related psychological distress, thereby reducing quality of life [5] .…”