Evidence map›Paper›PMID 35986926›Full record

ArticleBritish journal of clinical pharmacology2023

Association of income and educational levels on initiation of oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study.

Konsta Teppo, Jussi Jaakkola, Fausto Biancari, Olli Halminen, Miika Linna, Jari Haukka, Jukka Putaala, Pirjo Mustonen, Janne Kinnunen, Juha Hartikainen and 2 more

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In one paragraph

Article in British journal of clinical pharmacology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
1.5field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 10 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Social drivers in atrial fibrillation occurrence, screening, treatment, and outcomes: systematic-narrative hybrid review.European heart journal supplements : journal of the European Society of Cardiology · 2024
    Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 5 institutions in 3 countries.

Konsta TeppoUniversity of Turku, Turku, Finland.ORCID 0000-0002-4460-0994
Jussi JaakkolaUniversity of Turku, Turku, Finland.
Fausto BiancariHeart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
Olli HalminenDepartment of Industrial Engineering and Management, Aalto University, Espoo, Finland.
Miika LinnaAalto University, Espoo, Finland.
Jari HaukkaUniversity of Helsinki, Faculty of Medicine, Clinicum, Helsinki, Finland.
Jukka PutaalaNeurology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland.
Pirjo MustonenHeart Center, Turku University Hospital, Turku, Finland.
Janne KinnunenNeurology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland.
Juha HartikainenUniversity of Eastern Finland, Kuopio, Finland.
K E Juhani AiraksinenUniversity of Turku, Turku, Finland.
Mika LehtoDepartment of Industrial Engineering and Management, Aalto University, Espoo, Finland.
University of Helsinki · FIUniversity of Turku · FIUniversity of Eastern Finland · FIAalto University · FITurku University Hospital · FI

Funding

Aarne Koskelo FoundationFinnish Foundation for Cardiovascular ResearchHelsinki and Uusimaa Hospital District Research Fund
6 · The paper itself

Abstract

aimsSocioeconomic disparities have been reported in the outcomes of patients with atrial fibrillation (AF). We assessed the hypothesis that AF patients with higher income or educational level are more frequently initiated with oral anticoagulant (OAC) therapy for stroke prevention.

methodsThe nationwide registry-based Finnish AntiCoagulation in Atrial Fibrillation cohort covers all patients with AF from all levels of care in Finland. Patients were divided into income quartiles according to their highest annual income during 2004-2018 and into three categories based on educational attainment. The outcome was the first redeemed OAC prescription.

resultsWe identified 239 222 patients (mean age 72.7 ± 13.2 years, 49.8% female) with incident AF during 2007-2018. Higher income was associated with higher OAC initiation rate: compared to the lowest income quartile the adjusted SHRs (95% CI) for OAC initiation were 1.09 (1.07-1.10), 1.13 (1.11-1.14) and 1.13 (1.12-1.15) in the second, third and fourth income quartiles, respectively. Patients in the highest educational category had a slightly lower OAC initiation rate than patients in the lowest educational category (adjusted SHR 0.92 [95% CI 0.90-0.93]). Income-related disparities were larger and education-related disparities only marginal among patients at high risk of ischemic stroke. The socioeconomic disparities in OAC initiation within 1-year follow-up decreased from 2007 to 2018. The adoption of direct OACs as the initial anticoagulant was faster among patients with higher income or educational levels.

conclusionThese findings highlight potential missed opportunities in stroke prevention, especially among AF patients with low income, whereas the education-related disparities in OAC initiation appear controversial.

Indexed as

Atrial FibrillationStrokeAdministration, OralAgedAged, 80 and overAnticoagulantsCohort StudiesEducational StatusFemaleFinlandHumansMaleMiddle AgedRisk FactorsAnticoagulantsatrial fibrillationeducationincomeoral anticoagulationsocioeconomic factorsstroke prevention

Identifiers

PMID35986926
PMCPMC10087474
OpenAlexW4292461693

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.