Rural-urban differences in the initiation of oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study

• Published in: PloS one Vol. 17; no. 10; p. e0276612
• Main Authors: Teppo, Konsta, Jaakkola, Jussi, Langén, Ville L, Biancari, Fausto, Halminen, Olli, Linna, Miika, Haukka, Jari, Putaala, Jukka, Mustonen, Pirjo, Kinnunen, Janne, Luojus, Alex, Hartikainen, Juha, Airaksinen, K E Juhani, Lehto, Mika
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 31-10-2022; Public Library of Science (PLoS)
• Subjects: Administration, Oral; Age; Aged; Alcohol use; Anticoagulants; Anticoagulants (Medicine); Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Cardiac arrhythmia; Cardiovascular disease; Care and treatment; Cohort analysis; Cohort Studies; Complications and side effects; Coronary vessels; Dementia; Diabetes; Earth Sciences; Educational attainment; Female; Fibrillation; Finland - epidemiology; Gender; Heart failure; Humans; Hypertension; Male; Medicine and Health Sciences; Mental disorders; Mortality; Patient outcomes; Patients; Risk Factors; Rural areas; Social Sciences; Stroke; Stroke - chemically induced; Stroke - epidemiology; Stroke - prevention & control; Therapy; Transient ischemic attack; Urban areas; Urbanization; Variables; Vein & artery diseases; Finland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0276612

Little is known about rural-urban differences in the treatment and outcomes in patients with atrial fibrillation (AF). We aimed to assess whether the initiation of oral anticoagulant (OAC) therapy in patients with AF differs between those with rural and urban residence.
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 outcome was the first redeemed OAC prescription.
We identified 222 419 patients (50.1% female; mean age 72.8 (SD 13.2) years) with incident AF during 2007-2018. Urban residence was associated with a lower rate of OAC therapy initiation (adjusted subdistribution hazard ratio (SHR) (95% CI) 0.96 (0.95-0.97)). Correspondingly, an inverse graded dose-response relationship was observed between higher urbanization degree tertile and OAC initiation rate (highest tertile compared to lowest: adjusted SHR (95% CI) 0.94 (0.93-0.95)). The adoption of direct oral anticoagulants for stroke prevention was faster among patients with urban residence.
This nationwide cohort study documented that urban residence is associated with a slightly lower rate of OAC therapy initiation in patients with incident AF, but faster adoption of direct oral anticoagulant use.