Association of income and educational levels with adherence to direct oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study
Abstract Low socioeconomic status has been associated with poor outcomes in patients with atrial fibrillation (AF). However, little is known about socioeconomic disparities in adherence to stroke prevention with direct oral anticoagulants (DOACs). We assessed the hypothesis that AF patients with hig...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-06-01
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| Series: | Pharmacology Research & Perspectives |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/prp2.961 |
| _version_ | 1818471155845038080 |
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| author | Konsta Teppo Jussi Jaakkola Fausto Biancari Olli Halminen Miika Linna Jari Haukka Jukka Putaala Paula Tiili Ossi Lehtonen Mikko Niemi Pirjo Mustonen Janne Kinnunen Juha Hartikainen K. E. Juhani Airaksinen Mika Lehto |
| author_facet | Konsta Teppo Jussi Jaakkola Fausto Biancari Olli Halminen Miika Linna Jari Haukka Jukka Putaala Paula Tiili Ossi Lehtonen Mikko Niemi Pirjo Mustonen Janne Kinnunen Juha Hartikainen K. E. Juhani Airaksinen Mika Lehto |
| author_sort | Konsta Teppo |
| collection | DOAJ |
| description | Abstract Low socioeconomic status has been associated with poor outcomes in patients with atrial fibrillation (AF). However, little is known about socioeconomic disparities in adherence to stroke prevention with direct oral anticoagulants (DOACs). We assessed the hypothesis that AF patients with higher income or educational levels have better adherence to DOACs in terms of treatment implementation and persistence. The used nationwide registry‐based FinACAF cohort covers all patients with incident AF starting DOACs in Finland during 2011–2018. The implementation analyses included 74 222 (mean age 72.7 ± 10.5 years, 50.8% female) patients, and persistence analyses included 67 503 (mean age 75.3 ± 8.9 years, 53.6% female) patients with indication for permanent anticoagulation (CHA2DS2‐VASc score >1 in men and >2 in women). Patients were divided into income quartiles and into three categories based on their educational attainment. Therapy implementation was measured using the medication possession ratio (MPR), and patients with MPR ≥0.90 were defined adherent. Persistence was measured as the incidence of therapy discontinuation, defined as the first 135‐day period without DOAC purchases after drug initiation. Patients with higher income or education were consistently more likely adherent to DOACs in the implementation phase (comparing the highest income or educational category to the lowest: adjusted odds ratios 1.18 (1.12–1.25) and 1.21 (1.15–1.27), respectively). No association with income or educational levels was observed on the incidence of therapy discontinuation. In conclusion, we observed that income and educational levels both have independent positive association on the implementation of DOAC therapy but no association on therapy persistence in patients with AF. |
| first_indexed | 2024-04-13T21:47:00Z |
| format | Article |
| id | doaj.art-36206cd34b25456785526f3ad97daad7 |
| institution | Directory Open Access Journal |
| issn | 2052-1707 |
| language | English |
| last_indexed | 2024-04-13T21:47:00Z |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pharmacology Research & Perspectives |
| spelling | doaj.art-36206cd34b25456785526f3ad97daad72022-12-22T02:28:32ZengWileyPharmacology Research & Perspectives2052-17072022-06-01103n/an/a10.1002/prp2.961Association of income and educational levels with adherence to direct oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort studyKonsta Teppo0Jussi Jaakkola1Fausto Biancari2Olli Halminen3Miika Linna4Jari Haukka5Jukka Putaala6Paula Tiili7Ossi Lehtonen8Mikko Niemi9Pirjo Mustonen10Janne Kinnunen11Juha Hartikainen12K. E. Juhani Airaksinen13Mika Lehto14University of Turku Turku FinlandUniversity of Turku Turku FinlandHeart and Lung Center Helsinki University Hospital Helsinki FinlandDepartment of Industrial Engineering and Management Aalto University Espoo FinlandAalto University Espoo FinlandUniversity of Helsinki Helsinki FinlandNeurology Helsinki University Hospital and University of Helsinki Helsinki FinlandUniversity of Helsinki Helsinki FinlandAalto University Espoo FinlandUniversity of Helsinki Helsinki FinlandHeart Center Turku University Hospital Turku FinlandNeurology Helsinki University Hospital and University of Helsinki Helsinki FinlandUniversity of Eastern Finland Kuopio FinlandUniversity of Turku Turku FinlandHeart and Lung Center Helsinki University Hospital Helsinki FinlandAbstract Low socioeconomic status has been associated with poor outcomes in patients with atrial fibrillation (AF). However, little is known about socioeconomic disparities in adherence to stroke prevention with direct oral anticoagulants (DOACs). We assessed the hypothesis that AF patients with higher income or educational levels have better adherence to DOACs in terms of treatment implementation and persistence. The used nationwide registry‐based FinACAF cohort covers all patients with incident AF starting DOACs in Finland during 2011–2018. The implementation analyses included 74 222 (mean age 72.7 ± 10.5 years, 50.8% female) patients, and persistence analyses included 67 503 (mean age 75.3 ± 8.9 years, 53.6% female) patients with indication for permanent anticoagulation (CHA2DS2‐VASc score >1 in men and >2 in women). Patients were divided into income quartiles and into three categories based on their educational attainment. Therapy implementation was measured using the medication possession ratio (MPR), and patients with MPR ≥0.90 were defined adherent. Persistence was measured as the incidence of therapy discontinuation, defined as the first 135‐day period without DOAC purchases after drug initiation. Patients with higher income or education were consistently more likely adherent to DOACs in the implementation phase (comparing the highest income or educational category to the lowest: adjusted odds ratios 1.18 (1.12–1.25) and 1.21 (1.15–1.27), respectively). No association with income or educational levels was observed on the incidence of therapy discontinuation. In conclusion, we observed that income and educational levels both have independent positive association on the implementation of DOAC therapy but no association on therapy persistence in patients with AF.https://doi.org/10.1002/prp2.961adherenceatrial fibrillationdirect oral anticoagulantseducational levelincomepersistence |
| spellingShingle | Konsta Teppo Jussi Jaakkola Fausto Biancari Olli Halminen Miika Linna Jari Haukka Jukka Putaala Paula Tiili Ossi Lehtonen Mikko Niemi Pirjo Mustonen Janne Kinnunen Juha Hartikainen K. E. Juhani Airaksinen Mika Lehto Association of income and educational levels with adherence to direct oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study Pharmacology Research & Perspectives adherence atrial fibrillation direct oral anticoagulants educational level income persistence |
| title | Association of income and educational levels with adherence to direct oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study |
| title_full | Association of income and educational levels with adherence to direct oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study |
| title_fullStr | Association of income and educational levels with adherence to direct oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study |
| title_full_unstemmed | Association of income and educational levels with adherence to direct oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study |
| title_short | Association of income and educational levels with adherence to direct oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study |
| title_sort | association of income and educational levels with adherence to direct oral anticoagulant therapy in patients with incident atrial fibrillation a finnish nationwide cohort study |
| topic | adherence atrial fibrillation direct oral anticoagulants educational level income persistence |
| url | https://doi.org/10.1002/prp2.961 |
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