Temporal trends of gender disparities in oral anticoagulant use in patients with atrial fibrillation

Abstract

AimsTo 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.MethodsThe 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.ResultsWe 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.ConclusionThis 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.

Sex disparities for patients with atrial fibrillation in the direct oral anticoagulant era

“…9 Nonetheless, data addressing the temporal trends of OAC prescriptions over time from the pre-NOAC era to the latest era remain scarce. In the paper by Teppo et al, 10 the authors evaluated the annual trends of OAC initiation in newly diagnosed AF patients between 2007 and 2018 using the nationwide cohort data from national healthcare 10 show that overall, female patients had a significantly lower rate of OAC initiation than men even after adjustment for possible confounders; however, the differences tended to become attenuated and were minimal in the latter observation period when the indication of OAC was comparable to the current era, especially among OAC eligible patients. Hence, the sex disparity in OACprescribing for stroke prevention in AF could be improving over time (especially in the NOAC era) although OAC still tended to be under-prescribed to female patients.…”