心房颤动患者的酒精使用障碍与口服抗凝疗法的启动：一项全国性队列研究

IF 4.1 2区医学 Q1 PSYCHIATRY

General hospital psychiatry Pub Date : 2025-02-04 DOI:10.1016/j.genhosppsych.2025.01.017

Miika Vanhanen , Jussi Jaakkola , Juhani K.E. Airaksinen , Olli Halminen , Jukka Putaala , Pirjo Mustonen , Jari Haukka , Juha Hartikainen , Alex Luojus , Mikko Niemi , Miika Linna , Mika Lehto , Konsta Teppo

{"title":"心房颤动患者的酒精使用障碍与口服抗凝疗法的启动：一项全国性队列研究","authors":"Miika Vanhanen , Jussi Jaakkola , Juhani K.E. Airaksinen , Olli Halminen , Jukka Putaala , Pirjo Mustonen , Jari Haukka , Juha Hartikainen , Alex Luojus , Mikko Niemi , Miika Linna , Mika Lehto , Konsta Teppo","doi":"10.1016/j.genhosppsych.2025.01.017","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Patients with alcohol use disorders (AUD) often receive inferior care for somatic comorbidities. Our objective was to explore whether AUDs influence oral anticoagulant (OAC) initiation for stroke prevention among atrial fibrillation (AF) patients, using a nationwide dataset to assess treatment disparities.</div></div><div><h3>Methods</h3><div>The Finnish AntiCoagulation in Atrial Fibrillation registry includes data on all 229,565 patients diagnosed with incident AF in Finland during 2007–2018, identified from national registries covering all levels of care. The main outcome was OAC initiation compared between patients with and without AUD.</div></div><div><h3>Results</h3><div>The patients' mean age was 72.7 years, 50 % were female, 85.0 % were eligible for OAC therapy (CHA<sub>2</sub>DS<sub>2</sub>-VA score ≥ 1), and 4.7 % had AUD. OAC therapy was initiated in a smaller proportion of patients with AUD compared to those without (52.5 % vs. 71.4 %, <em>p</em> < 0.001). This disparity remained significant even after adjusting for comorbidities, socioeconomic status, and laboratory values influencing OAC initiation (adjusted hazard ratio [HR] 0.68; 95 % confidence interval [0.66–0.71]). The absolute difference in OAC initiation between groups stayed consistent at approximately 20 % throughout the study period. Interaction analyses indicated that the association between AUD and lower OAC initiation was stronger in patients with lower income, lower educational attainment, and lower thrombocyte levels, but there was no significant interaction with sex, bleeding history, or hemoglobin levels.</div></div><div><h3>Conclusions</h3><div>AUDs are associated with a significantly lower rate of OAC initiation even after accounting for comorbidities that influence OAC initiation.</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"93 ","pages":"Pages 116-121"},"PeriodicalIF":4.1000,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Alcohol use disorder and initiation of oral anticoagulant therapy in patients with atrial fibrillation: A nationwide cohort study\",\"authors\":\"Miika Vanhanen , Jussi Jaakkola , Juhani K.E. Airaksinen , Olli Halminen , Jukka Putaala , Pirjo Mustonen , Jari Haukka , Juha Hartikainen , Alex Luojus , Mikko Niemi , Miika Linna , Mika Lehto , Konsta Teppo\",\"doi\":\"10.1016/j.genhosppsych.2025.01.017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>Patients with alcohol use disorders (AUD) often receive inferior care for somatic comorbidities. Our objective was to explore whether AUDs influence oral anticoagulant (OAC) initiation for stroke prevention among atrial fibrillation (AF) patients, using a nationwide dataset to assess treatment disparities.</div></div><div><h3>Methods</h3><div>The Finnish AntiCoagulation in Atrial Fibrillation registry includes data on all 229,565 patients diagnosed with incident AF in Finland during 2007–2018, identified from national registries covering all levels of care. The main outcome was OAC initiation compared between patients with and without AUD.</div></div><div><h3>Results</h3><div>The patients' mean age was 72.7 years, 50 % were female, 85.0 % were eligible for OAC therapy (CHA<sub>2</sub>DS<sub>2</sub>-VA score ≥ 1), and 4.7 % had AUD. OAC therapy was initiated in a smaller proportion of patients with AUD compared to those without (52.5 % vs. 71.4 %, <em>p</em> < 0.001). This disparity remained significant even after adjusting for comorbidities, socioeconomic status, and laboratory values influencing OAC initiation (adjusted hazard ratio [HR] 0.68; 95 % confidence interval [0.66–0.71]). The absolute difference in OAC initiation between groups stayed consistent at approximately 20 % throughout the study period. Interaction analyses indicated that the association between AUD and lower OAC initiation was stronger in patients with lower income, lower educational attainment, and lower thrombocyte levels, but there was no significant interaction with sex, bleeding history, or hemoglobin levels.</div></div><div><h3>Conclusions</h3><div>AUDs are associated with a significantly lower rate of OAC initiation even after accounting for comorbidities that influence OAC initiation.</div></div>\",\"PeriodicalId\":12517,\"journal\":{\"name\":\"General hospital psychiatry\",\"volume\":\"93 \",\"pages\":\"Pages 116-121\"},\"PeriodicalIF\":4.1000,\"publicationDate\":\"2025-02-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"General hospital psychiatry\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S016383432500026X\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PSYCHIATRY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"General hospital psychiatry","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S016383432500026X","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}

引用次数: 0

摘要

目的酒精使用障碍（AUD）患者通常对躯体合并症的护理较差。我们的目的是探讨AUDs是否影响心房颤动（AF）患者口服抗凝剂（OAC）预防卒中的启动，使用全国数据集评估治疗差异。芬兰房颤抗凝登记包括2007-2018年芬兰诊断为AF的所有229,565例患者的数据，这些数据来自国家登记，涵盖所有级别的护理。主要结局是比较有和无AUD患者的OAC起始。结果患者平均年龄72.7岁，女性占50%，85.0%符合OAC治疗条件（CHA2DS2-VA评分≥1），4.7%有AUD。与未接受OAC治疗的AUD患者相比，接受OAC治疗的AUD患者比例较小(52.5% vs. 71.4%, p <；0.001)。即使在调整了影响OAC起始的合并症、社会经济地位和实验室值后，这种差异仍然显著(调整风险比[HR] 0.68；95%置信区间[0.66-0.71])。在整个研究期间，两组之间OAC起始的绝对差异保持一致，约为20%。相互作用分析表明，在收入较低、受教育程度较低和血小板水平较低的患者中，AUD与较低OAC起始率之间的关联更强，但与性别、出血史或血红蛋白水平没有显著的相互作用。结论：即使考虑了影响OAC起始的合并症，saud仍与OAC起始率显著降低相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Alcohol use disorder and initiation of oral anticoagulant therapy in patients with atrial fibrillation: A nationwide cohort study

Objective

Patients with alcohol use disorders (AUD) often receive inferior care for somatic comorbidities. Our objective was to explore whether AUDs influence oral anticoagulant (OAC) initiation for stroke prevention among atrial fibrillation (AF) patients, using a nationwide dataset to assess treatment disparities.

Methods

The Finnish AntiCoagulation in Atrial Fibrillation registry includes data on all 229,565 patients diagnosed with incident AF in Finland during 2007–2018, identified from national registries covering all levels of care. The main outcome was OAC initiation compared between patients with and without AUD.

Results

The patients' mean age was 72.7 years, 50 % were female, 85.0 % were eligible for OAC therapy (CHA₂DS₂-VA score ≥ 1), and 4.7 % had AUD. OAC therapy was initiated in a smaller proportion of patients with AUD compared to those without (52.5 % vs. 71.4 %, p < 0.001). This disparity remained significant even after adjusting for comorbidities, socioeconomic status, and laboratory values influencing OAC initiation (adjusted hazard ratio [HR] 0.68; 95 % confidence interval [0.66–0.71]). The absolute difference in OAC initiation between groups stayed consistent at approximately 20 % throughout the study period. Interaction analyses indicated that the association between AUD and lower OAC initiation was stronger in patients with lower income, lower educational attainment, and lower thrombocyte levels, but there was no significant interaction with sex, bleeding history, or hemoglobin levels.

Conclusions

AUDs are associated with a significantly lower rate of OAC initiation even after accounting for comorbidities that influence OAC initiation.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

General hospital psychiatry 医学-精神病学

CiteScore

9.60

自引率

2.90%

发文量

125

审稿时长

20 days

期刊介绍： General Hospital Psychiatry explores the many linkages among psychiatry, medicine, and primary care. In emphasizing a biopsychosocial approach to illness and health, the journal provides a forum for professionals with clinical, academic, and research interests in psychiatry''s role in the mainstream of medicine.