Temporal trends and patient determinants of geographical variation in oral anticoagulant treatment of atrial fibrillation: a Danish nationwide cohort study in 2013–2022

Figures

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  Figure 1. Flow chart of the study cohort. Patients were included in the cohort on fulfilling all inclusion criteria: age ≥18 years, residing in Denmark for at least five consecutive years, diagnosed with atrial fibrillation and with a CHA2DS2-VASc score of ≥2. Patients were excluded if they had a history of left atrial appendage closure procedure. During the study period, patients entered the cohort once all inclusion criteria were met. The last criterion fulfilled is depicted in the flow chart. Patients were followed until they reached one of the following endpoints: undergoing a left atrial appendage closure procedure, death, emigration or end of study, whichever came first. The white boxes indicate patients entering the cohort, and the grey boxes indicate patients leaving the cohort.

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  Figure 2. Temporal development in adherence to oral anticoagulant treatment in 2013–2022. Adherence to anticoagulant treatment by year for the full cohort and individual administrative regions, standardised by age and gender. PDC, proportion of days covered.

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  Figure 3. Changes in usage of oral anticoagulants for atrial fibrillation in 2013–2022. Distribution of dispensed oral anticoagulant agents among patients with atrial fibrillation. Stacked-area plot shows the relative contribution of each subgroup by year. (A) Nationwide distribution; (B) regional distributions. OAC, oral anticoagulant treatment.

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  Figure 4. Temporal development in the variation of adherence to anticoagulant therapy across geographical regions. Fully adjusted IRRs of adherence across the Danish administrative regions (adjusted for patient age, gender, health status, 38 long-term conditions defined in the Danish Multimorbidity Index (online supplemental table 2) and patient’s socioeconomic characteristics (origin, education, employment, income, cohabitation). IRR, incidence rate ratio.

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  Figure 5. Impact of patent determinants on adherence to oral anticoagulant treatment stratified by region in 2013–2022. For all estimates, the reference group (IRR=1) is the unexposed group in the same region (full cohort in reference model). The results are presented as IRRs with 95% CIs. All models were adjusted for sex, age and comorbidities defined in the Danish Multimorbidity Index (online supplemental table 1). Origin, income and cohabitation were adjusted for all conditions; multimorbidity only for mental health conditions, mental health status only for non-mental health conditions. P values are provided for no interaction between exposure variable and region of residence. IRR, incidence rate ratio.