Ina Grønkjær Laugesen, Anders Prior, Flemming Bro, Anna Mygind, Erik Lerkevang Grove
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Concurrently, the predominant treatment shifted from vitamin K antagonists to direct OACs with a preference for rivaroxaban and apixaban. The adherence variation between the highest-performing and lowest-performing regions decreased from 18% in 2013 to 9% in 2022, whereas the relative between-regions rankings remained unchanged. Applying multivariate Poisson models adjusting for patient demographics, health status and socioeconomic factors did not substantially change the inter-regional variations; this suggests that different compositions of patient populations cannot explain these variations. However, the impact of socioeconomic factors and comorbidities among patients was unequal across regions. In regions with the lowest overall adherence, a higher risk of non-adherence was seen among patients having mental health disorders, low income and living alone.</p><p><strong>Conclusions: </strong>The geographical variation in OAC adherence decreased over time as the overall adherence improved. However, substantial variation remained.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e098129"},"PeriodicalIF":2.4000,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Temporal trends and patient determinants of geographical variation in oral anticoagulant treatment of atrial fibrillation: a Danish nationwide cohort study in 2013-2022.\",\"authors\":\"Ina Grønkjær Laugesen, Anders Prior, Flemming Bro, Anna Mygind, Erik Lerkevang Grove\",\"doi\":\"10.1136/bmjopen-2024-098129\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To investigate temporal trends in the geographical variation in oral anticoagulant (OAC) treatment of patients with atrial fibrillation, to evaluate the extent to which regional differences in patient populations may explain this difference and to explore whether patient predictors of adherence may have a different impact across regions.</p><p><strong>Design: </strong>Register-based cohort study from 1 January 2013 to 31 December 2022.</p><p><strong>Setting: </strong>The study used data from nationwide health registers to explore differences in OAC adherence across the five administrative regions in Denmark.</p><p><strong>Participants: </strong>Patients with atrial fibrillation and a CHA<sub>2</sub>DS<sub>2</sub>-VASc score ≥2 (n=291 666).</p><p><strong>Outcome: </strong>Population adherence to OAC treatment operationalised as the proportion of days covered (PDC).</p><p><strong>Results: </strong>A continuous rise in overall adherence (PDC) from 53% to 78% was observed during the study period. Concurrently, the predominant treatment shifted from vitamin K antagonists to direct OACs with a preference for rivaroxaban and apixaban. The adherence variation between the highest-performing and lowest-performing regions decreased from 18% in 2013 to 9% in 2022, whereas the relative between-regions rankings remained unchanged. Applying multivariate Poisson models adjusting for patient demographics, health status and socioeconomic factors did not substantially change the inter-regional variations; this suggests that different compositions of patient populations cannot explain these variations. However, the impact of socioeconomic factors and comorbidities among patients was unequal across regions. In regions with the lowest overall adherence, a higher risk of non-adherence was seen among patients having mental health disorders, low income and living alone.</p><p><strong>Conclusions: </strong>The geographical variation in OAC adherence decreased over time as the overall adherence improved. 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Temporal trends and patient determinants of geographical variation in oral anticoagulant treatment of atrial fibrillation: a Danish nationwide cohort study in 2013-2022.
Objectives: To investigate temporal trends in the geographical variation in oral anticoagulant (OAC) treatment of patients with atrial fibrillation, to evaluate the extent to which regional differences in patient populations may explain this difference and to explore whether patient predictors of adherence may have a different impact across regions.
Design: Register-based cohort study from 1 January 2013 to 31 December 2022.
Setting: The study used data from nationwide health registers to explore differences in OAC adherence across the five administrative regions in Denmark.
Participants: Patients with atrial fibrillation and a CHA2DS2-VASc score ≥2 (n=291 666).
Outcome: Population adherence to OAC treatment operationalised as the proportion of days covered (PDC).
Results: A continuous rise in overall adherence (PDC) from 53% to 78% was observed during the study period. Concurrently, the predominant treatment shifted from vitamin K antagonists to direct OACs with a preference for rivaroxaban and apixaban. The adherence variation between the highest-performing and lowest-performing regions decreased from 18% in 2013 to 9% in 2022, whereas the relative between-regions rankings remained unchanged. Applying multivariate Poisson models adjusting for patient demographics, health status and socioeconomic factors did not substantially change the inter-regional variations; this suggests that different compositions of patient populations cannot explain these variations. However, the impact of socioeconomic factors and comorbidities among patients was unequal across regions. In regions with the lowest overall adherence, a higher risk of non-adherence was seen among patients having mental health disorders, low income and living alone.
Conclusions: The geographical variation in OAC adherence decreased over time as the overall adherence improved. However, substantial variation remained.
期刊介绍：
BMJ Open is an online, open access journal, dedicated to publishing medical research from all disciplines and therapeutic areas. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around fully open peer review and continuous publication, publishing research online as soon as the article is ready.
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