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Aims Atrial fibrillation (AF) patients frequently require active rhythm control therapy to maintain sinus rhythm and reduce symptom burden. Our study assessed whether antiarrhythmic therapies (AATs) are used disproportionately between men and women after new-onset AF. Methods and results The nationwide Finnish anticoagulation in AF registry-based linkage study covers all patients with new-onset AF in Finland during 2007–2018. Study outcomes included initiation of AATs in the form of antiarrhythmic drugs (AADs), cardioversion, or catheter ablation. The study population constituted of 229 565 patients (50% females). Women were older than men (76.6 ± 11.8 vs. 68.9 ± 13.4 years) and had higher prevalence of hypertension or hyperthyroidism, but lower prevalence of vascular disease, diabetes, renal disease, and cardiomyopathies than men. Overall, 17.6% of women and 25.1% of men were treated with any AAT. Women were treated with AADs more often than men in all age groups [adjusted subdistribution hazard ratio (aSHR) 1.223, 95% confidence interval (CI) 1.187–1.261]. Cardioversions were also performed less often on women than on men aged <65 years (aSHR 0.722, 95% CI 0.695–0.749), more often in patients ≥ 75 years (aSHR 1.166, 95% CI 1.108–1.227), while no difference between the sexes existed in patients aged 65–74 years. Ablations were performed less often in women aged <65 years (aSHR 0.908, 95% CI 0.826–0.998) and ≥75 years (aSHR 0.521, 95% CI 0.354–0.766), whereas there was no difference in patients aged 65–74 years. Conclusion Women used more AAD than men in all age groups but underwent fewer cardioversion and ablation procedures when aged <65 years. [ABSTRACT FROM AUTHOR]

Aims: To investigate sex‐specific temporal trends in the initiation of oral anticoagulant (OAC) therapy among patients diagnosed with atrial fibrillation (AF) in Finland between 2007 and 2018. Methods: The registry‐linkage Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) Study included all patients with incident AF in Finland from 2007 to 2018. The primary outcome was the initiation of any OAC therapy. Results: We identified 229,565 patients with new‐onset AF (50.0% women; mean age 72.7 years). The initiation of OAC therapy increased continuously during the observation period. While women were more likely to receive OAC therapy overall, after adjusting for age, stroke risk factors and other confounding factors, female sex was associated with a marginally lower initiation of OACs (unadjusted and adjusted hazard ratios comparing women to men: 1.08 (1.07–1.10) and 0.97 (0.96–0.98), respectively). Importantly, the gender disparities in OAC use attenuated and reached parity by the end of the observation period. Furthermore, when only patients eligible for OAC therapy according to the contemporary guidelines were included in the analyses, the gender inequalities in OAC initiation appeared minimal. Implementation of direct OACs for stroke prevention was slightly slower among women. Conclusion: This nationwide retrospective cohort study covering all patients with incident AF in Finland from 2007 to 2018 observed that although female sex was initially associated with a lower initiation of OAC therapy, the sex‐related disparities resolved over the course of the study period. [ABSTRACT FROM AUTHOR]

View large Download slide View large Download slide OBJECTIVES Our goal was to study the outcome of patients with cardiogenic shock who were treated with venoarterial extracorporeal membrane oxygenation (VA ECMO), including the subsequent long-term health-related quality of life (HRQoL). METHODS We conducted a retrospective study of 133 consecutive patients treated in a single centre from 2007 to 2016. The HRQoL was studied using the EuroQuol-5 dimensions-3 level questionnaire and the RAND 36-Item Short Form Health Survey at a minimum of 1 year after VA ECMO. RESULTS Of all patients, 66 (49.6%) were weaned from VA ECMO and 16 (12.0%) patients were bridged directly to a transplant, 15 (11.3%) to a ventricular assist device and 1 (0.8%) to a total artificial heart. Survival to discharge was 63.9% and to 1 year, 60.9%. A higher in-hospital mortality rate was independently associated with lower HCO3 at VA ECMO implantation [odds ratio (OR) 1.2/decrease of 1 mmol/l in HCO3 (95% confidence interval 1.1–1.3, P < 0.001)] and with increased need of red blood cells transfused during intensive care [OR 1.9/unit of red blood cells needed/day (95% confidence interval 1.4–2.6, P   < 0.001)]. HRQoL measured with the EuroQuol-5 dimensions-3 level questionnaire was equal to the HRQoL of the general population. In the 36-Item Short Form questionnaire, patients reported better emotional well-being and equal energy, pain and general health perception compared to the general population. Limitations were experienced only in physical health. In total, 56% of the patients ≤ 60 years had returned to work. CONCLUSIONS VA ECMO can provide acceptable long-term survival with good HRQoL for selected patients with refractory cardiogenic shock. Timing of patient assessment and of VA ECMO implantation is essential because deeper acidosis is associated with a higher in-hospital mortality rate. [ABSTRACT FROM AUTHOR]

AbstractBackgroundPatients with atrial fibrillation (AF) are often treated with antiarrhythmic drugs (AADs) to maintain sinus rhythm and with heart rate-lowering drugs to achieve optimal rate control. In this study we investigated trends in the use of AADs and rate control drugs in Finnish patients with AF.Methods and resultsThe Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study is a nationwide study including all patients with AF in Finland from 2007 to 2018. The number of AAD purchases and the proportions of all prevalent AF patients in a certain year of interest were calculated.In total, 391030 AF patients were identified between 2007 and 2018, and 39816 (10.2%) of them had purchased either class I or III AADs. The proportion of patients using class I and III AADs decreased from 8.6% to 6.3%. Flecainide and amiodarone were the most often used AADs. The use of flecainide and amiodarone decreased from 4.9% to 3.9% and 1.9% to 1.5%, respectively. The proportion of patients on beta-blockers remained stable at 75%. Dronedarone became available in 2011 when it also was the most used (0.8% of patients), but the use decreased thereafter. The use of sotalol and digoxin decreased from 1.5% to 0.6% and 24.6% to 11.0% over the study period.ConclusionThe number of AAD purchases increased alongside with the increasing prevalence of AF, whereas the proportion of AF patients on class I and III AADs and digoxin decreased between 2007 and 2018. Flecainide remained the most used AAD followed by amiodarone. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is a major risk factor for ischemic stroke (IS), but whether the magnitude of this risk has changed over time is unknown., Objectives: This study sought to investigate temporal trends in IS rates in patients with incident AF before oral anticoagulant agent (OAC) therapy., Methods: The nationwide FinACAF (Finnish Anticoagulation in Atrial Fibrillation) study covers patients with AF at all levels of care in Finland from 2007 to 2018. A 4-week quarantine period from AF diagnosis was applied, and only follow-up time without OAC therapy was included. Incidence rates of IS were computed in 4-year intervals in relation to sex and non-sex CHA 2 DS 2 -VASc (ie, CHA 2 DS 2 -VA) score values., Results: In total, 129,789 patients with new-onset AF were identified (49.2% women; mean age: 71.4 ± 14.5 years). Between the calendar year intervals of 2007-2010 and 2015-2018, the patients' mean CHA 2 DS 2 -VA score increased from 2.5 to 3.0, and concurrently the overall IS rate decreased by 25% from 36.7 to 27.6 events per 1,000 patient-years. This trend was driven by a 32% decrease of IS rate in women, particularly among those with higher age and CHA 2 DS 2 -VA scores. The IS rate in patients with a CHA 2 DS 2 -VA score of 1 was 8.2 events per 1,000 patient-years and remained stable across the study period., Conclusions: The initial IS risk in AF patients, before the initiation of OAC therapy, has decreased by 25% between 2007 and 2018 despite an increase in both age and stroke risk scores. The decrease has been most pronounced in older women with high stroke risk scores., Competing Interests: Funding Support and Author Disclosures This work was supported by the Aarne Koskelo Foundation, Finnish Foundation for Cardiovascular Research, Finnish State Research funding, and Helsinki and Uusimaa Hospital District research fund (TYH2019309). Dr Teppo has received research grants from the Finnish Foundation for Cardiovascular Research and the Aarne and Aili Turunen Foundation. Dr Airaksinen has received research grants from the Finnish Foundation for Cardiovascular Research; has served as a speaker for Bayer, Pfizer, and Boehringer Ingelheim; and has been a member of the Advisory Board for Bayer, Pfizer, and AstraZeneca. Dr Putaala has served as a speaker for Bayer, Boehringer Ingelheim, BMS-Pfizer, and Abbott; has served on the Advisory Board for Portola, Novo Nordisk, and Herantis Pharma; has served as a visiting editor for Terve Media; and holds stock ownership in Vital Signum. Dr Haukka has served as a research consultant for Janssen R&D and as a speaker for Bayer Finland. Dr Salmela has served as a speaker for BMS, Boehringer Ingelheim, and Pfizer; and has served on the Advisory Board for Pfizer. Dr Linna has served as a speaker for BMS-Pfizer Alliance, Bayer, and Boehringer Ingelheim. Aapo Aro has received research grants from the Finnish Foundation for Cardiovascular Research and has served as a speaker for Abbott, Johnson & Johnson, Sanofi, Bayer, and Boehringer Ingelheim. Dr Mustonen has served as a consultant for Roche, BMS-Pfizer Alliance, Novartis Finland, Boehringer Ingelheim, and MSD Finland. Dr Hartikainen has received research grants from the Finnish Foundation for Cardiovascular Research, European Union’s Horizon 2020, and EU FP7; has been a member of the Advisory Board for BMS-Pfizer Alliance, Novo Nordisk, and Amgen; and has served as a speaker for Cardiome and Bayer. Dr Lehto has served as a consultant for BMS-Pfizer Alliance, Bayer, Boehringer Ingelheim, and MSD; has served as a speaker for BMS-Pfizer Alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media, and Orion Pharma; and has received research grants from Aarne Koskelo Foundation, the Finnish Foundation for Cardiovascular Research, Helsinki and Uusimaa Hospital District research fund, and Boehringer Ingelheim. Dr Lip has served as a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, and Anthos (no fees were received personally) and is a National Institute for Health and Care Research senior investigator and co-principal investigator of the AFFIRMO project on multimorbidity in atrial fibrillation, which has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement no. 899871. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Aims: Atrial fibrillation (AF) patients frequently require active rhythm control therapy to maintain sinus rhythm and reduce symptom burden. Our study assessed whether antiarrhythmic therapies (AATs) are used disproportionately between men and women after new-onset AF., Methods and Results: The nationwide Finnish anticoagulation in AF registry-based linkage study covers all patients with new-onset AF in Finland during 2007-2018. Study outcomes included initiation of AATs in the form of antiarrhythmic drugs (AADs), cardioversion, or catheter ablation. The study population constituted of 229 565 patients (50% females). Women were older than men (76.6 ± 11.8 vs. 68.9 ± 13.4 years) and had higher prevalence of hypertension or hyperthyroidism, but lower prevalence of vascular disease, diabetes, renal disease, and cardiomyopathies than men. Overall, 17.6% of women and 25.1% of men were treated with any AAT. Women were treated with AADs more often than men in all age groups [adjusted subdistribution hazard ratio (aSHR) 1.223, 95% confidence interval (CI) 1.187-1.261]. Cardioversions were also performed less often on women than on men aged <65 years (aSHR 0.722, 95% CI 0.695-0.749), more often in patients ≥ 75 years (aSHR 1.166, 95% CI 1.108-1.227), while no difference between the sexes existed in patients aged 65-74 years. Ablations were performed less often in women aged <65 years (aSHR 0.908, 95% CI 0.826-0.998) and ≥75 years (aSHR 0.521, 95% CI 0.354-0.766), whereas there was no difference in patients aged 65-74 years., Conclusion: Women used more AAD than men in all age groups but underwent fewer cardioversion and ablation procedures when aged <65 years., Competing Interests: Conflict of interest: B.S.: speaker—BMS-Pfizer Alliance and Boehringer Ingelheim; member of advisory board—Pfizer; educational grants—Medtronic and Abbott. K.K.: Finnish Foundation for Cardiovascular Research. J.I.: speaker—Boehringer Ingelheim, BMS-Pfizer Alliance, and Boston Scientific; educational grants—Boston Scientific, Johnson & Johnson, and Medtronic. A.L.A.: research grants—Finnish Foundation for Cardiovascular Research and Sigrid Juselius Foundation; speaker—Abbott, Johnson & Johnson, Sanofi, Bayer, and Boehringer Ingelheim. K.T.: research grants—the Finnish Foundation for Cardiovascular Research, Aarne and Aili Turunen Foundation, and Finnish State Research funding. T.P.: BMS-Pfizer Alliance and Boehringer Ingelheim. J.P.: speaker—Bayer, Boehringer Ingelheim, BMS-Pfizer Alliance, and Abbott; advisory board—Portola, Novo Nordisk, and Herantis Pharma; visiting editor—Terve Media; stock ownership—VitalSignum. M.Li.: speaker—BMS-Pfizer Alliance, Bayer, and Boehringer Ingelheim. P.M.: consultant—Roche, BMS-Pfizer Alliance, Novartis Finland, Boehringer Ingelheim, and MSD Finland. J.H.: research grants—the Finnish Foundation for Cardiovascular Research; advisory board member—BMS-Pfizer Alliance, Novo Nordisk, and Amgen; speaker—Cardiome and Bayer. K.E.J.A.: research grants—the Finnish Foundation for Cardiovascular Research; speaker—Bayer, Pfizer, and Boehringer Ingelheim; advisory board member—Bayer, Pfizer, and AstraZeneca. M.Le.: consultant—BMS-Pfizer Alliance, Bayer, Boehringer Ingelheim, and MSD; speaker—BMS-Pfizer Alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media, and Orion Pharma; research grants—Aarne Koskelo Foundation, the Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund. All remaining authors have declared no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Objectives: Atrial fibrillation (AF) is associated with increased mortality. Previous studies have reported conflicting results in temporal trends of mortality after AF diagnosis. We aim to address this disparity by investigating the 1-year mortality and causes of death in Finnish patients diagnosed with AF between 2010 and 2017., Design: The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study is a nationwide retrospective register-based cohort study., Setting: The FinACAF study has gathered information on all Finnish AF patients between 2004 and 2018, with information from all national healthcare registers and data from all levels of care (primary, secondary and tertiary care)., Participants: We included patients with an incident AF diagnosis (International Classification of Diseases, 10th Revision code I48) between 2010 and 2017. To ensure a cohort of only incident AF, we excluded patients who used any oral anticoagulant during the year before cohort entry as well as patients with a recorded use of warfarin between 2004 and 2006. Patients under 20 years of age were excluded, and patients with permanent migration abroad before 1 January 2019 were excluded, N=157 658., Primary Outcome Measures: 1-year all-cause, cardiovascular (CV) and cause-specific mortality following AF diagnosis., Results: The study cohort consisted of 157 658 incident AF cases (50.1% male, mean age 72.9 years). Both all-cause and CV mortality declined from cohort entry years 2010-2017 (from 12.9% to 10.6%, mortality rate ratio (MRR) 0.77; 95% CI 0.73 to 0.82 in cohort entry year 2017 with 2010 as reference; and from 7.4% to 5.2%, MRR 0.68; 95% CI 0.63 to 0.74, respectively). Overall mortality and CV mortality were lower in women than in men throughout the study period (MRR 0.66; 95% CI 0.63 to 0.69 and MRR 0.53; 95% CI 0.50 to 0.56, respectively). Deaths attributable to ischaemic heart disease decreased during the study period (from 30.7% to 21.6%, MRR 0.51; 95% CI 0.49 to 0.62 in 2017 vs 2010), whereas dementia and Alzheimer's disease increased as a cause of death over time (6.2% to 9.9%, MRR 1.19; 95% CI 0.96 to 1.48 in 2017 vs 2010). The CHA 2 DS 2 -VASc score associated strongly with 1-year survival (p<0.0001)., Conclusions: Our study reiterates that mortality after diagnosis of AF has decreased. The CHA 2 DS 2 -VASc score highlights the need to treat comorbidities as it strongly associates with patient 1-year survival after initial AF diagnosis., Competing Interests: Competing interests: EK: none. BS: Speaker: BMS, Boehringer Ingelheim, Pfizer; Advisory board: Pfizer. AA: Research grants: Finnish Foundation for Cardiovascular Research; Speaker: Abbott, Johnson & Johnson, Sanofi, Bayer, Boehringer-Ingelheim. OH: none. KT: The Finnish Foundation for Cardiovascular Research. JHaukka: Consultant: Research Janssen R&D; Speaker: Bayer Finland. JP: Consultant: Boehringer-Ingelheim, Bayer, BMS-Pfizer, Abbott/St. Jude Medical, Vital Signum, Nokia Technologies, Bittium, BcB Medical, Herantis Pharma, Medixine and Portola. Speaker: Boehringer-Ingelheim, Bayer, BMS-Pfizer and Terve Media; Research grants: BMS-Pfizer, Abbott/St. Jude Medical, Business Finland, and Amgen. MLinna: Speaker: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim. PM: Consultant: Roche, BMS-Pfizer-alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland. JHartikainen: Research grants: The Finnish Foundation for Cardiovascular Research, Advisory Board Member: BMS-Pfizeralliance, Novo Nordisk, Amgen. Speaker: Cardiome, Bayer. JKEA Research grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer and Boehringer-Ingelheim. Member in the advisory boards: Bayer, Pfizer and AstraZeneca. MLehto: Consultant: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim and MSD; Speaker: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, MSD, Terve Media and Orion Pharma. Research grants: Aarne Koskelo Foundation, The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)