Konsta Teppo1, Jussi Jaakkola2, K E Juhani Airaksinen3, Fausto Biancari4, Olli Halminen5, Jukka Putaala6, Pirjo Mustonen3, Jari Haukka7, Juha Hartikainen8, Alex Luojus9, Mikko Niemi10, Miika Linna11, Mika Lehto12. 1. University of Turku, Turku, Finland. Electronic address: jkitep@utu.fi. 2. University of Turku, Turku, Finland; Heart Center, Turku University Hospital, Turku, Finland; Heart Unit, Satakunta Central Hospital, Pori, Finland. 3. University of Turku, Turku, Finland; Heart Center, Turku University Hospital, Turku, Finland. 4. Clinica Montevergine, GVM Care & Research, Mercogliano, Italy; Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland. 5. Aalto University, Espoo, Finland. 6. Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. 7. University of Helsinki, Helsinki, Finland. 8. University of Eastern Finland, Kuopio, Finland; Heart Center, Kuopio University Hospital, Kuopio, Finland. 9. University of Helsinki, Helsinki, Finland; Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland. 10. Department of Clinical Pharmacology, University of Helsinki, Helsinki, Finland; Individualized Drug Therapy Research Program, University of Helsinki, Helsinki, Finland; Department of Clinical Pharmacology, HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland. 11. Aalto University, Espoo, Finland; University of Eastern Finland, Kuopio, Finland. 12. University of Helsinki, Helsinki, Finland; Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland; Lohja Hospital, Department of Internal Medicine, Lohja, Finland.
Abstract
OBJECTIVE: Medication adherence is essential for effective stroke prevention in patients with atrial fibrillation (AF). We aimed to assess whether adherence to direct oral anticoagulants (DOACs) in AF patients is affected by the presence of mental health conditions (MHCs). METHODS: The nationwide FinACAF cohort covered 74,222 AF patients from all levels of care receiving DOACs during 2011-2018 in Finland. Medication possession ratio (MPR) was used to quantify adherence. Patients with MPR ≥0.90 were defined adherent. MHCs of interest were depression, bipolar disorder, anxiety disorder and schizophrenia. RESULTS: The patients' (mean age 75.4 ± 9.5 years, 50.8% female) mean MPR was 0.84 (SD 0.22), and 59.5% had MPR ≥0.90. Compared to patients without MHC, the adjusted ORs (95% CI) for adherent DOAC use emerged slightly lower in patients with depression (0.92 (0.84-0.99)) and bipolar disorder (0.77 (0.61-0.97)) and unsignificant in patients with anxiety disorder (1.08 (0.96-1.21)) and schizophrenia (1.13 (0.90-1.43)). However, when only persistent DOAC therapy was analyzed, no MHC was associated with poor adherence, and instead anxiety disorder was associated with adherent DOAC use (1.18 (1.04-1.34)). CONCLUSION: Adherence to DOACs in AF patients in Finland was relatively high, and no meaningful differences between patients with and without MHCs were observed.
OBJECTIVE: Medication adherence is essential for effective stroke prevention in patients with atrial fibrillation (AF). We aimed to assess whether adherence to direct oral anticoagulants (DOACs) in AF patients is affected by the presence of mental health conditions (MHCs). METHODS: The nationwide FinACAF cohort covered 74,222 AF patients from all levels of care receiving DOACs during 2011-2018 in Finland. Medication possession ratio (MPR) was used to quantify adherence. Patients with MPR ≥0.90 were defined adherent. MHCs of interest were depression, bipolar disorder, anxiety disorder and schizophrenia. RESULTS: The patients' (mean age 75.4 ± 9.5 years, 50.8% female) mean MPR was 0.84 (SD 0.22), and 59.5% had MPR ≥0.90. Compared to patients without MHC, the adjusted ORs (95% CI) for adherent DOAC use emerged slightly lower in patients with depression (0.92 (0.84-0.99)) and bipolar disorder (0.77 (0.61-0.97)) and unsignificant in patients with anxiety disorder (1.08 (0.96-1.21)) and schizophrenia (1.13 (0.90-1.43)). However, when only persistent DOAC therapy was analyzed, no MHC was associated with poor adherence, and instead anxiety disorder was associated with adherent DOAC use (1.18 (1.04-1.34)). CONCLUSION: Adherence to DOACs in AF patients in Finland was relatively high, and no meaningful differences between patients with and without MHCs were observed.
Authors: Konsta Teppo; Jussi Jaakkola; Fausto Biancari; Olli Halminen; Miika Linna; Jari Haukka; Jukka Putaala; Pirjo Mustonen; Janne Kinnunen; Alex Luojus; Saga Itäinen-Strömberg; Juha Hartikainen; Aapo L Aro; K E Juhani Airaksinen; Mika Lehto Journal: Int J Cardiol Heart Vasc Date: 2022-06-13
Authors: Konsta Teppo; Jussi Jaakkola; Fausto Biancari; Olli Halminen; Miika Linna; Jari Haukka; Jukka Putaala; Paula Tiili; Ossi Lehtonen; Mikko Niemi; Pirjo Mustonen; Janne Kinnunen; Juha Hartikainen; K E Juhani Airaksinen; Mika Lehto Journal: Pharmacol Res Perspect Date: 2022-06
Authors: Konsta Teppo; Jussi Jaakkola; Fausto Biancari; Olli Halminen; Jukka Putaala; Pirjo Mustonen; Jari Haukka; Miika Linna; Janne Kinnunen; Alex Luojus; Saga Itäinen-Strömberg; Tero Penttilä; Mikko Niemi; Juha Hartikainen; Ke Juhani Airaksinen; Mika Lehto Journal: BMJ Open Date: 2022-08-30 Impact factor: 3.006
Authors: Konsta Teppo; Jussi Jaakkola; Fausto Biancari; Olli Halminen; Miika Linna; Jukka Putaala; Pirjo Mustonen; Janne Kinnunen; Santeri Jolkkonen; Mikko Niemi; Juha Hartikainen; K E Juhani Airaksinen; Mika Lehto Journal: Int J Cardiol Heart Vasc Date: 2022-10-10
Authors: Konsta Teppo; Jussi Jaakkola; Fausto Biancari; Olli Halminen; Miika Linna; Jari Haukka; Jukka Putaala; Pirjo Mustonen; Janne Kinnunen; Alex Luojus; Saga Itäinen-Strömberg; Juha Hartikainen; Aapo L Aro; K E Juhani Airaksinen; Mika Lehto Journal: Int J Environ Res Public Health Date: 2022-09-06 Impact factor: 4.614