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Nicklas Vinter

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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  • Nicklas Vinter
  • Olli Halminen, Aalto University
  • ,
  • Mika Lehto, University of Helsinki
  • ,
  • K E Juhani Airaksinen, University of Turku
  • ,
  • Tomas Andersson, Karolinska Institutet
  • ,
  • Per Wändell, Karolinska Institutet
  • ,
  • Martin Holzmann, Karolinska Institutet
  • ,
  • Ole-Christian Rutherford, University of Oslo
  • ,
  • Sigrun Halvorsen, University of Oslo
  • ,
  • Pia Cordsen, Aalborg University
  • ,
  • Lars Frost
  • Søren Paaske Johnsen, Aalborg University

Aim: To examine inter-national 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.

Original languageEnglish
Book seriesBasic & Clinical Pharmacology & Toxicology
Pages (from-to)168-178
Number of pages11
Publication statusPublished - Aug 2023

    Research areas

  • atrial fibrillation, mortality, oral anticoagulation, stroke, variation, Administration, Oral, Humans, Risk Factors, Treatment Outcome, Anticoagulants/adverse effects, Finland/epidemiology, Denmark/epidemiology, Atrial Fibrillation/drug therapy, Stroke/epidemiology, Sweden/epidemiology, Cohort Studies

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