Rural–Urban differences in Use of Rhythm Control Therapies in Patients with Incident Atrial Fibrillation: A Finnish Nationwide Cohort Study

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 and Mika Lehto
Additional contact information
Konsta Teppo: Faculty of Medicine, University of Turku, 20500 Turku, Finland
Jussi Jaakkola: Faculty of Medicine, University of Turku, 20500 Turku, Finland
Fausto Biancari: Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
Olli Halminen: Department of Industrial Engineering and Management, Aalto University, 02150 Espoo, Finland
Miika Linna: Department of Industrial Engineering and Management, Aalto University, 02150 Espoo, Finland
Jari Haukka: University of Helsinki, 00014 Helsinki, Finland
Jukka Putaala: Neurology, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
Pirjo Mustonen: Heart Center, Turku University Hospital, 20014 Turku, Finland
Janne Kinnunen: Neurology, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
Alex Luojus: Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
Saga Itäinen-Strömberg: Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
Juha Hartikainen: University of Eastern Finland, 70211 Kuopio, Finland
Aapo L. Aro: Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
K. E. Juhani Airaksinen: Faculty of Medicine, University of Turku, 20500 Turku, Finland
Mika Lehto: Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland

IJERPH, 2022, vol. 19, issue 18, 1-10

Abstract: Background: Rural–urban disparities have been reported in the access, utilization, and quality of healthcare. We aimed to assess whether use of antiarrhythmic therapies (AATs) in patients with atrial fibrillation (AF) differs between those with rural and urban residence. Methods: The registry-based FinACAF cohort covers all patients with AF from all levels of care in Finland. Patients were divided into rural and urban categories and into urbanization degree tertiles based on their municipality of residence at the time of AF diagnosis. The primary outcome was the use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription. Results: We identified 177,529 patients (49.9% female, mean age 73.0 (SD13.0) years) with incident AF during 2010–2018. Except for AADs, the differences in AAT use were nonsignificant when patients were stratified according to the rural–urban classification system (urban vs. rural adjusted incidence rate ratios (aIRRs) with 95% CIs for any AAT 1.01 (0.99–1.03), AADs 1.11 (1.07–1.15), cardioversion 1.01 (0.98–1.03), catheter ablation 1.05 (0.98–1.12)). However, slightly higher use of all rhythm control modalities was observed in the highest urbanization degree tertile when compared to the lowest tertile (aIRRs with 95% Cis for any AAT 1.06 (1.03–1.08), AADs 1.18 (1.14–1.23), cardioversion 1.05 (1.02–1.08), catheter ablation 1.10 (1.02–1.19)). Conclusions: This nationwide retrospective cohort study observed that urban residence is associated with higher use of AADs in patients with incident AF. Otherwise, the observed disparities were only marginal, suggesting that in the use of rhythm control therapies, no large rural–urban inequity exists in Finland.

Keywords: atrial fibrillation; rural–urban disparities; rhythm control therapies; antiarrhythmic drugs; cardioversion; ablation (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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