Finnish Hospital Research Articles

Advantages in Management and Remote Monitoring of Intravenous Therapy: Exploratory Survey and Economic Evaluation of Gravity-Based Infusions in Finland

IntroductionIntravenous infusion therapy is a common and challenging invasive treatment procedure in hospital wards. Administration mistakes can have serious, even life-threatening, consequences. The Monidor solution was developed to help nurses administer gravity-based infusions and monitor them remotely, to avoid complications and reduce workload. Its real-world effects and economic consequences were unknown.MethodsAn exploratory survey was carried out to estimate the potential impact of the Monidor solution on events and nurse time use. At the end of their shift, nurses estimated effects in terms of routine room visits avoided, prevention of complications, and impact on nurse time requirements. Linear regression was applied to estimate predictors of time freed. A health economic model was developed to evaluate economic consequences and to calculate the net return on investment for a hypothetical hospital ward. A 1-month time horizon was used, and discounting was not applied.ResultsA total of 216 responses were obtained from 6 Finnish hospitals, from a total of 15 wards, and 56.3% of nurses found that the Monidor solution freed nurse time, while < 3.5% experienced additional time requirements. Per nurse shift, the Monidor solution avoided on average 2.064 routine room visits, helped detect end of infusion 1.340 times, and led to 5.045 min of time freed. One routine visit avoided was associated with 2.453 min of time freed in the linear regression. In the conservative setting, the freed monthly capacity in the hypothetical ward amounted to €1270.90 per month (year 2021), yielding a return on investment of 2.63. Uncertainty of linear regression coefficient values was identified as a driver of uncertainty in sensitivity analysis, with return on investment ranging from 1.55 to 3.71.ConclusionsThe study demonstrated that management and remote monitoring with the Monidor solution frees nurse time and reduces routine activities associated with gravity-based intravenous infusions. These findings could be confirmed in a comparative empirical study.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02093-6.

The effect of COVID-19 lockdown on the incidence of emergency department visits due to injuries and the most typical fractures in 4 Finnish hospitals.

Background and purposeCOVID-19 lockdowns have affected personal mobility and behavior worldwide. This study compared the number of emergency department (ED) visits due to injuries and typical low-energy fractures in Finland during the COVID-19 lockdown period in spring 2020 to the reference period in 2019.Patients and methodsThe data was collected retrospectively from the electronic patient records of 4 hospitals covering 1/5 of the Finnish population. We included the patients who were admitted to a hospital ED due to any injury during the lockdown period (March 18–May 31, 2020) and the reference period (March 18–May 31, 2019). We compared the differences between the average daily ED admissions in the 2 years using the zero-inflated Poisson regression model.ResultsThe overall number of ED visits due to injuries decreased by 16% (mean 134/day vs. 113/day, 95% CI –18 to –13). The number of ED visits due to wrist fractures decreased among women aged over 50 years by 40% (CI –59 to –9). Among women, the number of ED visits due to ankle fractures decreased by 32% (CI –52 to –5). The number of ED visits due to fractures of the upper end of the humerus decreased by 52% (CI –71 to –22) among women. The number of ED visits due to hip fractures increased by 2% (CI –16 to 24).InterpretationRestrictions in personal mobility decreased the number of ED visits due to injuries during the pandemic. The effect can mainly be seen as a decreased number of the most typical low-energy fractures among women. In contrast, lockdown restrictions had no effect on the number of hip fractures.

Less revascularization in young women but impaired long-term outcomes in young men after myocardial infarction.

Female sex has previously been associated with poorer outcomes after myocardial infarction (MI), although evidence is scarce among young patients. We studied sex differences in cardiovascular outcomes after MI in young patients &lt;55 years old. Consecutive young (18-54 years) all-comer patients with out-of-hospital MI admitted to 20 Finnish hospitals (n = 8934, 17.3% women) in 2004-2014 were studied by synergizing national registries. Differences between the sexes were balanced by inverse probability weighting. The median follow-up period was 9.1 years (max 14.8 years). Young women with MI had more comorbidities at baseline, were revascularized less frequently, and received fewer evidence-based secondary prevention medications (P2Y12 inhibitors, renin-angiotensin signalling pathway inhibitors, statins, and lower statin dosages) after MI than young men. Long-term mortality or the occurrence of major adverse cardiovascular events (MACE; recurrent MI, stroke, or cardiovascular death) did not differ between the sexes in the unadjusted analysis. However, after baseline feature and treatment-difference adjustment, men had poorer outcomes after MI. Adjusted long-term mortality was 21.3% in men vs. 17.2% in women [hazard ratio (HR) 1.29; 95% confidence interval (CI) 1.10-1.53; P = 0.002]. Cumulative MACE rate was 33.9% in men vs. 27.9% in women during follow-up (HR 1.23; 95% CI 1.09-1.39; P = 0.001). Recurrent MI and cardiovascular death occurrences were more frequent among men. Stroke occurrence did not differ between the sexes. Young women were found to receive less active treatment after MI than young men. Nevertheless, male sex was associated with poorer long-term cardiovascular outcomes after MI in young patients after baseline feature adjustment.

Increasing Use of PET-CT, Neoadjuvant Treatment, Minimally Invasive Approach and Surgical Radicality in Esophageal Cancer Surgery are Associated with Improved Short- and Long-term Outcomes in Real-World Setting

BackgroundGuideline adherence has improved outcomes in several cancers. Our aim was to evaluate whether the rate of PET-CT, neoadjuvant treatment, minimally invasive approach, and surgical radicality, suggested also by recent guidelines, would improve short- and long-term operative outcomes in esophageal cancer in real-world setting. MethodsThis retrospective study in two Finnish Hospitals between 2010 and 2020 included 296 esophageal cancer patients. Grouping factors based on four factors with annual cut-offs by center were 90% rate in PET-CT-based staging, 70% in neoadjuvant therapy usage, 80% in minimally invasive approach, and 20 in annual mean lymph node yield. If none of factors were reached, all patients operated in that year were classified into group 1. With one to three cut-offs reached, grouping was into group 2. If all annual cut-offs were reached, patients were classified into group 3. Primary end points were major complication rate and overall 1-, 3-, and 5-year survival. ResultsMajor complication rate decreased significantly from 38.2% in group 1 (p < 0.001) and 34.2% in group 2 (p < 0.001) to 10.2% in group 3. Overall 1-, 3-, and 5-year survival rates between groups 1–3 were 77.9% vs. 80.3% vs. 94.2% (p = 0.004), 51.5% vs. 51.1% vs. 67.3% (p = 0.022), and 44.1% vs. 47.4% vs. 55.5% (p = 0.065), respectively. Adjusted 5-year overall mortality was reduced significantly in group 3 compared to group 1 (HR 0.46, 95% CI 0.28–0.75). ConclusionThis study suggests that increasing rate of PET-CT, neoadjuvant treatment, minimally invasive surgery, and surgical radicality improves short- and long-term outcomes in operated esophageal cancer patients.

Low incidence of clinically relevant bleeding complications after fast-track arthroplasty: a register study of 8,511 arthroplasties.

Background and purposeFast-track total joint replacement (TJR) has become increasingly common. Routine thromboprophylaxis for pulmonary embolism and deep venous thrombosis prevention lasts from 2 to 5 weeks. This retrospective registry study focused on clinically relevant bleeding complications 90 days after fast-track primary TJR.Patients and methodsAll primary fast-track total hip (THA) and knee arthroplasties (TKA) performed between 2015 and 2016 were extracted from the Finnish Arthroplasty Register and Finnish Hospital Discharge Register. Type of arthroplasty and indication for the operation were combined with diagnoses of clinically relevant bleeding complications within 90 days of surgery. The incidence of these bleedings was the primary outcome measure.ResultsOf the total of 8,511 patients (mean age 67 years (SD 10); 60% female), 45% underwent unilateral THA, 52% unilateral TKA, and 3% bilateral TKA. The incidence of clinically relevant bleeding complications within 90 days was 1% (95% CI 0.8–1.3). No difference was observed in bleeding incidence between the groups. The 87 bleedings comprised 57 operative site bleedings, 17 gastrointestinal bleedings, 6 intracranial non-traumatic bleedings, 5 bleedings from the nose or another undetermined site, and 2 intraocular bleedings. 1 death due to intracranial bleeding was recorded, and hence clinically relevant bleeding-specific 90-day mortality was 0.01%.InterpretationThe incidence of clinically relevant bleeding complications was low. However, they cause patient discomfort, increase the use of healthcare services, and can be life-threatening and even fatal.

Real-world data on diffuse large B-cell lymphoma in 2010-2019: usability of large data sets of Finnish hospital data lakes.

Background: Real-world data on diffuse large B-cell lymphoma (DLBCL) has remained incomplete. In Finland, health record data originally recorded in different hospital data record systems are collectively available via data lake technology, enabling efficient extraction and analysis of large data sets. The usability of Finnish data lake data in the assessment of DLBCL was evaluated. Methods: Adult DLBCL patients diagnosed between 2010 and 2019, home municipality in the Hospital District of Southwest Finland and data available in respective data lake were included. Results: The algorithmic determination of treatment lines and respective survival was successful. Patient characterization was feasible, albeit partly incomplete because of limited data content/availability and coverage. Stage, International Prognostic Index and cell of origin were available for 63.0, 68.3 and 28.4% of patients, respectively. Genetic aberrations were not structurally available or feasible to extract without a manual chart review. Conclusion: Finnish data lakes represent an efficient way to analyze large DLBCL data sets. The current study provides a tool for developing recording practices in routine care.

Emergency department visits due to hand trauma and subsequent emergency hand surgery in three Finnish hospitals during the first and second waves of COVID-19 pandemic.

The rate of acute hand trauma visits to emergency departments (ED) and surgeries decreased during the COVID-19 lockdown. Our aim was to analyze the influence of national lockdown during the first wave and the regional restrictions during the second wave on the rate of visits to the ED and urgent hand surgeries in Finland. Material for this retrospective study was gathered from three Finnish hospitals All ED visits and urgent or emergency surgeries from January 2017 to December 2020 were included. Incidences per 100 000 persons with 95% confidence intervals (CI) were calculated and compared by incidence rate ratios (IRR). The incidence of hand injury was lower after the beginning of the lockdown in March 2020 (IRR 0.70 CI 0.63-0.78). After lockdown ended in May, the monthly incidences of ED visits returned to the reference level. During the lockdown, the incidence of fractures and dislocations was 42% lower in March (IRR 0.58 CI 0.50-0.68) and 33% lower in April 2020 (IRR 0.67 CI 0.57-0.80). The incidence of fracture repair surgeries was 43% lower in March 2020 (IRR 0.57 CI 0.35-0.93) and 41% lower in July 2020 (IRR 0.59 CI 0.36-0.98). Incidence of replantation was 49% higher in March 2020 (IRR 1.49 CI 0.53-4.20) and 200% higher in July 2020 (IRR 3.00 CI 0.68-13.2) but these increases had high uncertainty. The rate of ED visits due to hand injuries decreased while the rate of emergency hand operations remained unchanged during the national COVID-19 lockdown in spring. After the lockdown, the incidences returned to reference level and were unaffected by regional restrictions during the second wave of pandemic.

Outdoor education in a Finnish hospital school: Let’s open the doors and take a forest walk

Outdoor education in a Finnish hospital school: Let’s open the doors and take a forest walk

Public health care innovation lab tackling the barriers of public sector innovation

ABSTRACT Acknowledging the public sector’s remarkable innovation potential and several challenges hindering its innovation capability, this case study explores the impact of public sector innovation laboratory on innovation barriers of public health care. Findings are based on a Finnish hospital district’s innovation laboratory specialized as an authentic environment to develop novel technology and service solutions with various private sector partners. By altering the PSO’s approaches on interaction, commercialization, mutual learning and independence, the PSI laboratory proves especially influential in tackling innovation barriers related to complexity and organizational competences. Conversely, the lab’s impact on the barriers of risk-aversion and bureaucracy is lesser.

P161 Implementation of Outcome Measurement – Case Finnish IBD register

Abstract Background Inflammatory bowel diseases (IBD) are becoming increasingly common. In Finland, during 2020, in total of 54 000 patients were diagnosed with IBD, and over 2000 new diagnoses are made every year. The Finnish university hospitals in collaboration with BCB Medical Ltd have built disease-specific registers to support and monitor the quality and effectiveness of health care. The IBD register (IBDR) collects data on the effectiveness of IBD treatments and their follow-up, where e.g. disease severity, treatment and outcomes are profoundly monitored. As combination, IBDR, MyHealth service, and IBD Symptom Diary enables patients’ health, functional status, experience and QoL monitoring to reach the health care goals. The service supports patient treatment pathway and makes designing more personalized treatments for IBD possible. Methods The IBDR is a web-based system integrated with electronic health record (EHR) systems, through which patient data is captured. Nationally convergent register allows for peer review of treatment outcomes. To complement registers’ clinical data, PROMs are collected with online MyHealth service to enable automatic, recurring data collection directly from the patient. The first questionnaire is activated 14 days before the visit, whereas new questionnaire is sent to the patient two months after visit, and then at time points according to the disease activity index calculated from the questionnaire. The disease activity is reflecting the severity of the IBD symptoms[1]. Captured measures are immediately available for clinician review. Results MyHealth for IBD is actively used in four Finnish university hospitals and two central hospitals with some inter-regional variation. By November 2021, the questionnaires were answered 31 506 times since the beginning of the implementation in 2019. The response rate is yearly increasing (Figure 1). Distribution of disease activity index among IBD patients in Tampere University Hospital is shown in Figure 2. Conclusion IBDR enables the evaluation and comparison of patient care quality, which is not accessible through EHR systems alone. Our electronic data collection model brings out the patients’ voice and saves resources since cyclic questionnaires are automatically send to patients, and answers are immediately reached by clinician. In future, international comparison and monitoring of treatment outcomes will be emphasized. As MyHealth deployment proceeds across hospitals, the availability of the patient reported outcomes data will increase. International research and peer development will continue to be an essential part of our activities. Reference 1. Puolanne A-M et al. Dig Dis Sci (2017) 62:3123–3130.

Working hours, on-call shifts, and risk of occupational injuries among hospital physicians: A case-crossover study.

ObjectiveTo investigate the association of hospital physicians’ working hours and on‐call shifts with the risk of occupational injuries.MethodsIn this nested cohort study of 556 Finnish hospital physicians, we linked electronic records from working‐hour and on‐call duty payroll data to occupational injury data obtained from the Finnish Workers’ Compensation Center for the period 2005–2019. We used a case‐crossover design with matched intervals for a 7‐day ‘case window’ immediately prior to occupational injury and a ‘control window’ 7 days prior to the beginning of the case window, and analyzed their associations using conditional logistic regression models.ResultsWe noted 556 occupational injuries, 281 at the workplace and 275 while commuting. Having three to four long (>12 h) work shifts on the preceding 7 days was associated with a higher probability of an occupational injury (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.11, 4.09), and the OR for three to four on‐call shifts was 3.54 (95%CI 2.11, 5.92) in comparison to having none of these work shift types. A higher number of several consecutive working days was associated with a higher probability of injury in a dose‐response manner. Moreover, increasing weekly working hours was associated with an increased likelihood of injury (OR 1.03, 95%CI 1.01, 1.04), whereas the number of normal (≤12 h) work shifts reduced this likelihood (OR 0.79, 95%CI 0.64, 0.98).ConclusionsOur findings suggest that accumulated working‐hour load, as opposed to single, very long (>24 h) work shifts, may increase the risk of occupational injury among hospital physicians.

Risk of total knee replacement after proximal tibia fracture: a register-based study of 7,841 patients.

Background and purposePost-traumatic knee osteoarthritis following proximal tibia fracture (PTF) is a common complication that may lead to total knee replacement as secondary treatment (TKRS). We determined the risk of TKRS following PTF, whether treated nonoperatively or operatively, and compared the results with a 38-fold control group without prior PTF.Patients and methodsWe identified all patients over 18 years of age in Finland with PTF treated during the period 2009–2018 from the Finnish Hospital Discharge Register (FHDR) and Finnish Arthroplasty Register (FAR). Age, sex, treatment method, follow-up time, and possible TKRS were recorded.Results7,701 patients were treated for PTF during the period 2009–2018. Over the 5.1-year (SD 3.1) follow-up, TKRS was performed in 340 (4.3%) patients with a prior PTF after a mean of 2.1 (SD 2.0) years post-fracture. TKRS was needed in 138 (3.7%, HR 1.8) patients in the nonoperatively treated group and in 202 (5.0%, HR 3.2) patients in the operatively treated group. Operative treatment, female sex, and high age were identified as risk factors for TKRS. The incidence of TKRS was highest during the first 2 years after fracture and remained elevated throughout the follow-up.InterpretationPatients with a prior PTF had a 1.8- to 3.2-fold higher risk of TKRS compared with controls during the first 5 years post-fracture. Risk of TKRS was associated with an operatively treated PTF, female sex, and high age. The patients in the operative group likely sustained more complex fractures, while female sex and age may be explained by more osteoporotic bone quality.

Patients with Hidradenitis Suppurativa Suffer from Low Health-Related Quality of Life as Measured by the Generic 15D Instrument

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with various comorbidities and diminished quality of life (QoL). Among dermatological conditions, HS is reported to most severely diminish QoL. This study aimed to analyse the health-related QoL (HRQoL) of patients with HS in more detail by using generic to disease-specific HRQoL questionnaires. Correlations between the HRQoL measures and HS disease severity measures were assessed. Methods: We analysed the HRQoL and clinical severity of patients with HS (N = 92) treated in 5 Finnish hospitals using HRQoL measurement tools most often used in dermatological clinics, as well as the generic 15D instrument (standardized and self-administered 15-dimensional measure of HRQoL). The disease severity was assessed using the Hurley stage, International Hidradenitis Suppurativa Severity Score System, and disease severity evaluation by the investigator. Results: The mean 15D score of HS patients was low and comparable with that of patients with cancers. No correlation was found between HS severity measures and 15D score, indicating that even mild HS has a high impact on HRQoL. Conclusions: Our findings strengthen the understanding about HS as a debilitating disease and even compared with non-dermatological conditions and highlight the need of comprehensive care of patients with HS.

Men's experiences of the impact of penile cancer surgery on their lives: A qualitative study.

Surgery is the primary treatment for invasive penile cancer (PC). Postoperative changes in genital anatomy and function may lead to altered body and self-image, compromised sexual function and subsequent psychological problems. The aim of this study is to describe men's experiences of the impact of PC surgical treatment on their lives. The institutional databases of two Finnish university hospitals were searched for patients who underwent surgery for invasive PC between 2009 and 2019. Of 107 men, 29 agreed to an interview or a response letter. The data were analysed by thematic analysis. The men experienced that their self-image had changed after PC diagnosis and treatment to a 'cancer-modified me'. They also experienced that physical symptoms after surgery defined their everyday, as well as sexual, lives and that the whole content of life changed. Support and counselling for physical, mental, sexual and social factors should be part of the treatment of men with PC.

A Digital Care Pathway to Access Healthcare Without Time and Place Restrictions.

A digital care pathway is a secure digital service channel for patients in a care relationship with a specialized health care hospital in Finland. It is part of the Health Village portal built in co-operation with the Virtual Hospital project by five Finnish university hospitals led by Helsinki University Hospital. Health Village services make healthcare services available to all Finns regardless of place of residence and income level, thus improving the equality of citizens.

The extended late career phase – examining senior nursing professionals

PurposeBy relying on a sustainable career perspective and recent studies on senior employees’ late career phase, this study aims to examine senior (50+) nurses’ late career narratives in the context of extending retirement age. Given the current global nursing shortage, there is a pressing need to find ways on how to promote longer and sustainable careers in the health-care field. Yet, there is limited knowledge about the extended late career phase of senior nurses.Design/methodology/approachEmpirical data were derived from 22 interviews collected among senior (50+) nursing professionals working in a Finnish university hospital. The qualitative interview data were analysed using a narrative analysis method. As a result of the narrative analysis, four career narratives were constructed.FindingsThe findings demonstrated that senior nurses’ late career narratives differed in terms of late career aspirations, constraints, mobility and active agency of one’s own career. The identified career narratives indicate that the building blocks of sustainable late careers in the context of extending retirement age are diverse.Research limitations/implicationsThe qualitative interview data were restricted to senior nurses working in one university hospital. Interviews were conducted on site and some nurses were called away leaving some of the interviews shorter than expected.Practical implicationsTo support sustainable late careers requires that attention be based on the whole career ecosystem covering individual, organizational and societal aspects and how they are intertwined together.Originality/valueSo far, few studies have investigated the extended late career phase of senior employees in the context of a changing career landscape.

A randomized clinical trial comparing early patient-reported pain after open anterior mesh repair versus totally extraperitoneal repair of inguinal hernia.

This was a prospective, multicentre, non-blinded, randomized clinical trial involving two parallel groups of patients. Adult patients with symptomatic unilateral primary inguinal hernia were included in this study. Patients were enrolled and treated in five Finnish hospitals. Eligible patients were randomized by use of a computer-based program to receiving either open anterior repair (modified Lichtenstein) with glue mesh fixation or totally extraperitoneal (TEP) repair. The primary aims were to compare 30-day patient-reported pain scores and return to work after surgery between the two groups. A total of 202 patients were randomized: 98 patients to TEP repair and 104 patients to open repair. All randomized patients received their allocated treatment. A total of 86 patients (88 per cent) in the TEP group and 94 patients (90 per cent) in the Lichtenstein group completed the 30-day follow-up. Patients experienced less early pain (P < 0.001) and used less analgesics after TEP repair, compared to those who had modified Lichtenstein repair. Two patients in the TEP group and five in the Lichtenstein group developed superficial wound infection (P = 0⋅446). Only one reoperation was performed in the Lichtenstein group due to haematoma. TEP inguinal hernia repair is associated with less early postoperative pain compared to the open glue mesh fixation technique. NCT03566433 (http://www.clinicaltrials.gov).

Association of working hour characteristics and on-call work with risk of short sickness absence among hospital physicians: A longitudinal cohort study

ABSTRACT Physicians often work long hours and on-call shifts, which may expose them to circadian misalignment and negative health outcomes. However, few studies have examined whether these working hour characteristics, ascertained using objective working hour records, are associated with the physicians’ risk of sickness absence. We investigated the associations of 14 characteristics of payroll-based working hours and on-call work with the risk of short sickness absence among hospital physicians. In this cohort study, 2845 physicians from six Finnish hospital districts were linked to electronic payroll-based records of daily working hours, on-call duty and short (1–3 days) sickness absence between 2005 and 2019. A case-crossover design was applied using conditional logistic regression with the 28 day case and control windows to estimate odds ratios (ORs) and 95% confidence intervals (CI) for short sickness absence. After controlling for weekly working hours and the number of normal (≤12 h) shifts, a higher number of long (>12 h) shifts (ORs for ≥5 versus none: 2.54, 95% CI 1.68–3.84), very long (>24 h) shifts (ORs for ≥5 versus none: 2.62, 95%CI 1.61–4.27), and on-call shifts (OR for ≥5 versus none: 2.15, 95% CI 1.44–3.21) and a higher number of short (<11 h) shift intervals (OR for ≥5 versus none: 12.61, 95% CI 8.88–17.90) were all associated with the increased risk of short sickness absence. These associations did not differ between male and female physicians or between age groups. To conclude, the findings from objective working hour records show that long work shifts, on-call shifts and short shift intervals are related to the risk of short (1–3 days) sickness absence among hospital physicians.

Sex Differences in Cardiovascular Outcomes of Older Adults After Myocardial Infarction.

BackgroundEvidence on the impact of sex on prognoses after myocardial infarction (MI) among older adults is limited. We evaluated sex differences in long‐term cardiovascular outcomes after MI in older adults.Methods and ResultsAll patients with MI ≥70 years admitted to 20 Finnish hospitals during a 10‐year period and discharged alive were studied retrospectively using a combination of national registries (n=31 578, 51% men, mean age 79). The primary outcome was combined major adverse cardiovascular event within 10‐year follow‐up. Sex differences in baseline features were equalized using inverse probability weighting adjustment. Women were older, with different comorbidity profiles and rarer ST‐segment–elevation MI and revascularization, compared with men. Adenosine diphosphate inhibitors, anticoagulation, statins, and high‐dose statins were more frequently used by men, and renin‐angiotensin‐aldosterone inhibitors and beta blockers by women. After balancing these differences by inverse probability weighting, the cumulative 10‐year incidence of major adverse cardiovascular events was 67.7% in men, 62.0% in women (hazard ratio [HR], 1.17; CI, 1.13–1.21; P<0.0001). New MI (37.0% in men, 33.1% in women; HR, 1.16; P<0.0001), ischemic stroke (21.1% versus 19.5%; HR, 1.10; P=0.004), and cardiovascular death (56.0% versus 51.1%; HR, 1.18; P<0.0001) were more frequent in men during long‐term follow‐up after MI. Sex differences in major adverse cardiovascular events were similar in subgroups of revascularized and non‐revascularized patients, and in patients 70 to 79 and ≥80 years.ConclusionsOlder men had higher long‐term risk of major adverse cardiovascular events after MI, compared with older women with similar baseline features and evidence‐based medications. Our results highlight the importance of accounting for confounding factors when studying sex differences in cardiovascular outcomes.

Use of antihypertensive medication before diagnosis of atrial fibrillation in Finland – results from the nationwide FinACAF -study

Abstract Background and aims Long-standing arterial hypertension increases the risk of cardiovascular morbidity including atrial fibrillation (AF), coronary heart disease and renal failure. Arterial hypertension is the most common aetiologic factor associated with the development of AF and is also the most prevalent co-morbid cardiovascular disease in patients with AF. Coexisting arterial hypertension together with AF increases further the risk of stroke, heart failure and overall mortality. The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) -study is a nationwide retrospective register-based AF study that combines data from several Finnish health care registers. In this sub-study, we characterized the use of antihypertensive medications in patients with new-onset AF. Methods This sub-study included all adult new-onset AF patients of the FinACAF study from January 2007 to December 2018. Patients were excluded if they were under 18 years of age, had any oral anticoagulant purchase in the year prior to AF diagnosis, or had diagnosis of AF or warfarin purchases between the years 2004–2006. Appropriate data such as anonymized study ID's, ICD-10 diagnoses, and drug purchases (dates, ATC-codes, amounts) were obtained from the National Prescription Register as well as the Finnish Hospital and Primary care registers. The antihypertensive medication purchases from the year preceding the AF diagnosis were analysed and identified by appropriate ATC-codes. Purchases one-month prior to the new-onset AF diagnosis were excluded from in order to avoid confounding by any medication changes due to AF diagnosis. Results Of 229,282 patients with new-onset AF 164,527 (71.8%) had purchased antihypertensive medication during the year prior to the AF diagnosis. The most common antihypertensive drugs used were beta blockers (n=108,510; 47.3%), ACE-inhibitors or angiotensin receptor blockers (n=104,840; 45.7%), diuretics (n=79,270; 34.6%) and selective calcium channel blockers (n=61,610; 26.9%). Diltiazem was purchased by 2,001 patients (0.9%) and verapamil by 1,508 patients (0.7%). At the beginning of the study period, beta-blockers were the most widely used antihypertensive agents, but between 2007 and 2018, RAAS-inhibitors (ACE inhibitors and ARB blockers) became the most widely used group of antihypertensive drugs (Figure 1). Conclusion Most Finnish new-onset AF patients had at least one pre-existing antihypertensive medication in use before the diagnosis of AF. Beta blockers were the most common antihypertensives until the latest years when RAAS-inhibitors became the most prescribed antihypertensive agents, whereas the use of diltiazem and verapamil was marginal in the treatment of hypertension before the AF diagnosis. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Helsinki and Uusimaa Hospital District research fundThe Finnish Foundation for Cardiovascular Research Figure 1. Annual use of antihypertensive medication among Finnish new-onset AF patients prior to diagnosis. Annual number of new-onset AF patients plotted for reference.