
Miika LinnaAalto University · HEMA
Miika Linna
Aalto university and UEF
About
208
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Publications
Publications (208)
Background
Direct oral anticoagulants (DOACs) have largely replaced warfarin as the primary choice of oral anticoagulation (OAC) in atrial fibrillation (AF) patients. This study uses a nationwide registry data set to compare the health and social care costs of AF patients using different OAC therapies. We studied how these costs were distributed am...
Introduction
The prevalence of atrial fibrillation (AF) is strongly associated with age, and with increasing life expectancy worldwide, the number of AF patients has been steadily rising. However, long-term projections of AF prevalence are scarse.
Purpose
To predict the prevalence and the number of patients with AF in Finland from 2021 until 2070....
Background
Atrial fibrillation (AF) is associated with increased mortality, cardiovascular morbidity, and risk of stroke. With aging population, the number of AF patients is increasing, and they present with more comorbidities representing a major public health challenge.
Purpose
The influence of concomitant diseases on survival of patients with A...
Background
Catheter ablation is a well-established treatment to prevent atrial fibrillation (AF) and atrial flutter (AFL) recurrences and to relieve symptoms, whereas pacemaker implantation and atrioventricular node (AVN) ablation is used for rate control when medical therapy fails.
Aims
We investigated temporal trends and patient characteristics...
Background and Aims
Atrial fibrillation (AF) patients frequently require active rhythm control therapy to maintain sinus rhythm and reduce symptom burden. Our study assessed whether antiarrhythmic therapies (AATs) are used disproportionately between men and women after new-onset AF.
Methods
The nationwide Finnish anticoagulation in atrial fibrilla...
Background
Little is known how individual time-in-therapeutic-range (TTR) impacts the effectiveness and safety of warfarin therapy compared to direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF).
Objective
To compare the effectiveness and safety of standard dose DOACs to warfarin in patients with AF, while categorizing war...
Introduction:
Chronic kidney disease (CKD) is associated with an increased incidence of atrial fibrillation (AF). Also, patients with AF are prone to adverse kidney outcomes. We examined comorbidities and medication use in patients with CKD and incident AF.
Methods:
The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) is a nationwide ret...
Aims
Elective cardioversion (ECV) is routinely used in atrial fibrillation (AF) to restore sinus rhythm. However, it includes a risk of thromboembolism even during adequate oral anticoagulation treatment. The aim of this study was to evaluate the risk of thromboembolic and bleeding complications after ECV in a real-life setting utilizing data from...
Background
Contemporary data have shown a decrease in the ischaemic stroke risk associated with female sex in patients with atrial fibrillation (AF). We evaluated temporal trends in the predictive value of a non-sex CHA2DS2-VASc risk score (ie. CHA2DS2-VA).
Methods
The FinACAF study covers all patients with incident AF between 2007 and 2018 in Fin...
Background
Atrial fibrillation (AF) is a major risk factor for ischemic stroke (IS), but whether the magnitude of this risk has changed over time is unknown.
Purpose
To evaluate temporal trends in IS rates in patients with AF who have not initiated oral anticoagulant (OAC) therapy.
Methods
The registry-linkage Finnish AntiCoagulation in Atrial Fi...
Background and Aims
Atrial fibrillation (AF) is common in patients with chronic kidney disease (CKD). It is well known that CKD in AF patients increases the risk of thromboembolic complications, and also bleeding. However, there is lack of safety and efficacy data of oral anticoagulation (OAC) in patients with advanced CKD.
Method
The FinACAF stud...
Background and Aims
Female sex has been linked with higher risk of ischaemic stroke (IS) in atrial fibrillation (AF), but no prior study has examined temporal trends in the IS risk associated with female sex.
Methods
The registry-linkage Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study included all patients with AF in Finland from 20...
Objectives
The Finnish dental care market operates as a dual system, divided between a regulated, affordable public sector and a less regulated, more expensive private sector that receives public subsidies. In 2015 and 2016, two policy interventions were introduced to reduce these subsidies for private dental services. The aim of this study was to...
BACKGROUND
Limited data exist on the temporal relationship between new-onset atrial fibrillation (AF) and ischemic stroke and its impact on patients’ clinical characteristics and mortality.
METHODS
A population-based registry-linkage database includes all patients with new-onset AF in Finland from 2007 to 2018. Ischemic stroke temporally associate...
Objectives
Value-based healthcare (VBHC) is considered the most promising guiding principle for a new generation of health service production. Many countries have attempted to apply VBHC to managerial and clinical decision-making. However, implementation remains in its infancy and varies between countries. The objective of the study is to help heal...
Background and aims
Direct oral anticoagulants (DOACs) have replaced Vitamin-K antagonists as the primary choice of oral anticoagulation (OAC) in atrial fibrillation (AF). However, after several years of experience with DOACs, no studies have been made comparing the efficacy and safety of reduced dose DOACs and warfarin when the quality of warfarin...
Background
Mechanical aortic valve replacement (AVR) remains predominant treatment approach for younger patients in need of aortic valve operation. However, little is known about the success of the required Vitamin K Antagonist (VKA) treatment and its relation to adverse events.
Purpose
We assessed the quality of VKA treatment prior to ischemic ev...
Background
Atrial fibrillation (AF) is common among cancer patients. Oral anticoagulation therapy (OAT) is important to prevent stroke in AF patients, but active cancer may also predispose to bleeding. Current knowledge on the use of OAT among AF patients with active cancer is scarce.
Purpose
To assess the influence of active cancer on the initiat...
Background and purpose
Oral anticoagulation (OAC) is the cornerstone of thromboprophylaxis in atrial fibrillation (AF) yet complicated by elevated bleeding risk. We examined the temporal evolution of OAC treatment on 30-day fatality in patients with AF and first-ever hemorrhagic stroke (HS).
Methods
We identified the study population from the nati...
Background and aims
Direct oral anticoagulants (DOACs) have almost replaced warfarin in stroke prevention of patients with atrial fibrillation (AF). However, little is known whether DOACs are more efficacious or safer than warfarin having information on time-in-therapeutic-range (TTR) in the warfarin-treated patients.
Methods
The Finnish AntiCoagu...
Background
The impact of oral anticoagulants (OACs) on outcomes in patients with atrial fibrillation (AF) has been a focus of extensive research in the past decades, but there is a complete paucity of information about their effect on the need of long-term care (LTC) in this aging and multimorbid patient group.
Purpose
To assess the hypothesis tha...
Temporal Relation Between Myocardial Infarction and New-Onset Atrial Fibrillation: Results from a Nationwide Registry Study
Elin Karlsson, MDa, *, Tuomas Kiviniemi, MD, PhDb , Olli Halminen, PhDc , Ossi Lehtonen, MScc , Konsta Teppo, MD, PhDb , Jari Haukka, PhDa , Pirjo Mustonen, MD, PhDb , Jukka Putaala, MD, PhDa,d , Miika Linna, PhDe , Juha Harti...
Abstract
Introduction This study evaluated the effect of physical activity (PA) counselling on the number of contacts and related costs in primary healthcare (PHC) and specialised healthcare (SHC) among patients with type 2 diabetes (T2D).
Methods The study was carried out in North Karelia, Finland, among PHC clients with T2D in 2016–2018. Altoge...
Background
Ageing of the population increases the prevalence and co-existence of many chronic diseases, i.e. multimorbidity. In Finland, information on the significance of multimorbidity and its relation to healthcare capacity is scarce. We aimed to study the prevalence of multimorbidity, the transitions between patient groups with and without mult...
Aims
To 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.
Methods
The registry‐linkage Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) Study included all patients with incident AF in Finland from 2007 to 20...
Background
Ageing of the population increases the prevalence and coexistence of many chronic diseases; a condition called multimorbidity. In Finland, information on the significance of multimorbidity and its relation to the sustainability of healthcare is scarce.
Aim
To assess the prevalence of multimorbidity, the transitions between patient group...
Background
Sleep apnea is associated with chronic comorbidities and acute complications. Existing data suggest that sleep apnea may predispose to an increased risk and severity of respiratory tract infections.
Methods
We investigated the incidence of lower respiratory tract infections in the first and second year before and after diagnosis of slee...
Aims:
Rural-urban disparities have been reported in the outcomes of cardiovascular diseases. We assessed whether rural-urban or other geographical disparities exist in the risk of ischemic stroke (IS) and death in patients with atrial fibrillation (AF) in Finland.
Methods:
The registry-based FinACAF cohort study covers all patients with AF from...
Aims:
We assessed the temporal trends in the prevalence of diabetes and in its associations with outcomes among patients with atrial fibrillation (AF).
Methods:
The registry-based FinACAF study covered all patients with incident AF in Finland between 2007 and 2018. Ischemic stroke (IS) and mortality rates were computed using Poisson regression m...
Objectives:
The impact of oral anticoagulants (OACs) on the need of long-term care (LTC) in the aging and multimorbid population of patients with atrial fibrillation (AF) is unknown. We conducted a nationwide cohort study to evaluate the effect of OACs on the need of LTC.
Design:
Retrospective nationwide cohort study.
Setting and participants:...
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): The Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund.
Background and aims
Direct oral anticoagulants (DOACs) have largely replaced warfarin in patients with atrial fibrillation (AF) to reduce risk of...
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Sigrid Juselius foundation
Finnish Foundation for Cardiovascular Research
Background
Atrial flutter (AFL) is often encountered in atrial fibrillation (AF) patients. There are many similarities in the etiology and treatment of these arrhythmias, including the need...
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Helsinki and Uusimaa Hospital District TYH2019309 and The Finnish Foundation for Cardiovascular Research
Background/Introduction
Acute myocardial infarction (AMI) and atrial fibrillation (AF) are commonly seen in a same patient. It is not unusual that pat...
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Helsinki and Uusimaa Hospital District (TYH2019309) and The Finnish Foundation for Cardiovascular Research
Background and aims
Elderly patients with atrial fibrillation (AF) and patients with renal failure – for example – are recommended to use reduced do...
Background
Patients with aortic stenosis (AS) have been underrepresented in the trials evaluating direct oral anticoagulants (DOACs) in atrial fibrillation (AF). We aimed to assess whether AS impacts outcomes in patients with AF and estimate the effects of DOACs versus warfarin in patients with AF and AS.
Methods and Results
The registry‐based Fin...
Aims:
Guidelines on the management of atrial fibrillation (AF) have evolved significantly during the past two decades, but the concurrent developments in real-life management and prognosis of AF are unknown. We assessed trends in the treatment and outcomes of patients with incident AF between 2007 and 2017.
Methods and results:
The registry-base...
Objectives
To evaluate the association between health and social care costs and early start of anti-dementia medication in a nationwide cohort of Finnish Alzheimer’s disease (AD) patients.
Methods
The cohort included 7454 Finnish AD patients who had their first AD diagnosis in 2012 and lived at home at the time of diagnosis. Data were collected re...
Background
The study aim was to analyse how mental health services are used in different parts of the Kainuu region in Finland and whether travel time to primary health care services is associated with the use of different contact types (in-person visits, remote contacts, home visits).
Methods
The study population included adults who had used ment...
Objective
Atrial fibrillation (AF) is a worldwide healthcare challenge owing to population ageing. In this study, we assessed the current trends in the incidence and prevalence of AF for the first time in an unselected, nationwide population.
Methods
In the Finnish Anticoagulation in Atrial Fibrillation study, we gathered comprehensive data includ...
Aims
Little is known about rural-urban differences in the treatment and outcomes in patients with atrial fibrillation (AF). We aimed to assess whether the initiation of oral anticoagulant (OAC) therapy in patients with AF differs between those with rural and urban residence.
Methods
The registry-based FinACAF cohort covers all patients with AF fro...
Background and Aims: The risk of ischemic stroke associated with atrial fibrillation (AF) can be reduced with oral anticoagulation therapy (OAC). We examined the patient characteristics and nationwide use of OACs in primary and secondary care AF patients.
Methods: The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) -study is a nationwide s...
Background:
Low socioeconomic status has been associated with higher risk of ischemic stroke and death in patients with atrial fibrillation (AF). However, whether socioeconomic status affects risk of bleeding events is unknown. We assessed the hypothesis that low income and educational attainment are associated with higher risk of bleeding in pati...
Introduction
Prevalence of atrial fibrillation (AF) is strongly associated with age, and with longer life-time expectancy number of AF patients is worldwide strongly increasing. However, nationwide prevalence of AF is not known when primary care data as well is accessible.
Purpose
The FinACAF-study is a nationwide registry study including of all A...
Introduction
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with a current prevalence of 4.1% in Finland. Many of the comorbidities associated with AF are known risk factors for the arrhythmia and vice versa, as well as contributors to the risk of stroke and other AF related adverse events. A generally used evaluation met...
Background
Cardioversion is routinely used to restore sinus rhythm in patients with atrial fibrillation (AF). Elective cardioversion (ECV) is associated with an increased risk of thromboembolic complications even during adequate oral anticoagulation (OAC).
Purpose
The aim was to analyze the incidence of ischemic stroke and transient ischemic attac...
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 al...
Aims
Socioeconomic disparities have been reported in the outcomes of patients with atrial fibrillation (AF). We assessed the hypothesis that AF patients with higher income or educational level are more frequently initiated with oral anticoagulant (OAC) therapy for stroke prevention.
Methods
The nationwide registry‐based Finnish AntiCoagulation in...
Objectives
Mental health conditions (MHCs) have been associated with undertreatment of unrelated medical conditions, but whether patients with MHCs face disparities in receiving rhythm control therapies for atrial fibrillation (AF) is currently unknown. We assessed the hypothesis that MHCs are associated with a lower use of antiarrhythmic therapies...
The COVID-19 pandemic has caused changes in the availability and use of health services, and disruptions have been reported in chronic disease management. We aimed to study the impact of the pandemic on the incidence of chronic diseases in Finland using register-based data. Incident cases of chronic diseases decreased, except cases of anxiety disor...
Background
In patients with atrial fibrillation (AF), socioeconomic disparities have been reported in the use of oral anticoagulant therapy and outcomes, but whether income also affects the utilization of antiarrhythmic therapies (AATs) for rhythm control is unknown. We assessed the hypothesis that AF patients with higher income are more likely to...
Objective
We assessed the hypothesis that mental health conditions (MHCs) are associated with higher risk of bleeding in patients with atrial fibrillation (AF).
Methods
The registry-based FinACAF study covers all patients with AF diagnosed during 2007–2018 in Finland. MHCs of interest were depression, bipolar disorder, anxiety disorder, schizophre...
The aim of this study was to examine the views of key experts on developing and using cost-effectiveness calculators to plan and evaluate health and wellbeing promotion interventions in health and social services. Data for this qualitative interview study were collected from 14 Finnish experts in health and wellbeing coordination, health and social...
Background: Socioeconomic disparities can be associated with adverse outcomes in patients with cardiovascular diseases. The impact of personal income on the outcomes of patients with atrial fibrillation (AF) is unclear.
Methods: Nationwide observational registry-based study on patients with incident AF in Finland during 2007-2018.
Results: 203 154...
Background
Treatments should be customized to patients to improve patients’ health outcomes and maximize the treatment benefits. We aimed to identify meaningful data-driven trajectories of incident type 2 diabetes patients with similarities in glycated haemoglobin (HbA1c) patterns since diagnosis and to examine their clinical and economic relevance...
Low socioeconomic status has been associated with poor outcomes in patients with atrial fibrillation (AF). However, little is known about socioeconomic disparities in adherence to stroke prevention with direct oral anticoagulants (DOACs). We assessed the hypothesis that AF patients with higher income or educational levels have better adherence to D...
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Helsinki and Uusimaa Hospital District Funding The Finnish Foundation of Cardiovascular Research
Introduction
Initiation of oral anticoagulation (OAC) in case of a new-onset atrial fibrillation (AF) requires assessment of bleeding history. Gastrointestina...
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Sigrid Juselius Foundation
Background
Atrial fibrillation (AF) is recognized as a major public health problem due to increased mortality, morbidity and risk of stroke. Advanced age and burden of other comorbidities are potential contributors to AF development and...
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Sigrid Juselius Foundation
Introduction
Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide, and its prevalence is increasing with aging population. AF is associated with increased cardiovascular morbidity and mortality, but the prognosis o...
Background: Value-based healthcare (VBHC) is considered the most promising guiding principle for a new generation of health service production. Many countries have attempted to apply VBHC to managerial and clinical decision-making. However, implementation remains in its infancy and varies between countries. The objective of the study is to help hea...
The opioid epidemic in the U.S has gotten payers, prescribers, and policymakers alike interested in trends in opioid use. Despite no recognized opioid crisis in Europe, several countries have reported an increase in opioid-related deaths, which has further prompted discussion on the need of monitoring of opioid prescriptions. This study was conduct...
The prevalence of sleep apnoea is increasing globally; however, population-based studies have reported a wide variation of prevalence estimates, and data on incidence of clinically diagnosed sleep apnoea are scant. Data on the overall burden of comorbidities or multimorbidity in individuals with incident sleep apnoea are scarce, and the pathways to...
Background:
Atrial fibrillation (AF) patients with mental health conditions (MHCs) have higher incidence of ischemic stroke (IS) than patients without MHC, but whether this results from direct impact of MHCs or relates to higher prevalence of comorbidities and differences in the use of oral anticoagulant (OAC) therapy is unclear. We assessed the h...
Background
Mental health conditions (MHCs) are associated with poor outcomes in patients with atrial fibrillation. However, persistence of oral anticoagulation therapy in patients with atrial fibrillation and MHCs is unknown. We aimed to evaluate the effect of MHCs on the persistence of direct oral anticoagulant (DOAC) use in patients with atrial f...
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 le...
Atrial fibrillation (AF) is a major cause of ischemic stroke and the number of AF patients is increasing. Thus, up-to-date multifaceted data about the characteristics of AF patients, their treatments, and outcomes are urgently needed. The Finnish anticoagulation in atrial fibrillation (FinACAF) study has collected comprehensive data on all Finnish...
Background
Anticoagulant therapies are used to prevent atrial fibrillation-related strokes, with warfarin and direct oral anticoagulant (DOAC) the most common. In this study, we incorporate direct health care costs, drug costs, travel costs, and lost working and leisure time costs to estimate the total costs of the two therapies.
Methods
This retr...
Introduction: Thromboprophylaxis of patients with atrial fibrillation (AF) has changed in the past decade. How the changes manifest in real life is yet less studied. This study describes 30-day case fatality and prior anticoagulation in a nationwide cohort of patients with AF and first-ever ischemic stroke during the past decade.
Methods: FinACAF (...
Introduction: Little is known about the effects of mental health conditions (MHC) on the utilization of oral anticoagulant (OAC) therapy in patients with atrial fibrillation (AF). We assessed the hypothesis that MHCs are associated with a lower rate of OAC initiation in patients with incident AF.
Methods: The FinACAF registry included all 239 756 p...
Introduction: Mental health conditions (MHCs) have been associated with undertreatment of unrelated medical conditions, but whether patients with MHCs face disparities in receiving antiarrhythmic therapies (AATs) for atrial fibrillation (AF) is currently unknown. We assessed the hypothesis that MHCs are associated with decreased use of AATs.
Method...
Background
Health coaching is a patient-centred approach to supporting self-management for the chronic conditions. However, long-term evidence of effectiveness of health coaching remains scarce. The object of this study was to evaluate the long-term effect of telephone health coaching (THC) on mortality and morbidity among people with type 2 diabet...