What is it about?

Since 2006, reforms have been implemented in Sweden that aim to increase freedom for patients to choose care providers and treatment. However, evaluations of Swedish healthcare system since such reforms have indicated socioeconomic inequalities in patient management and health outcomes. Since 2011, non-vitamin K antagonist oral anticoagulants (NOACs) – dabigatran, rivaroxaban and apixaban – have been available in Sweden as alternatives to warfarin for stroke prevention in atrial fibrillation (AF) and other indications. Although more expensive, this new class of drugs have more favourable benefit–risk profiles than warfarin and can be prescribed in fixed doses without routine monitoring of coagulation. We used data from linked national registers for the period 2011 to 2014 to investigate associations between sociodemographic factors and initial treatment with a NOAC vs. warfarin, the previous standard of care. Patients starting treatment with a NOAC were more likely to be highly educated, in the highest income quartile and have a leading professional occupation. Patients residing in rural areas were half as likely to start treatment with a NOAC as those in urban areas. Therefore, among Swedish patients with NVAF, those with high socioeconomic status and urban residence were more likely to start preventative treatment with a NOAC than warfarin. Future research should explore reasons for these inequalities in NOAC treatment.

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Why is it important?

The Swedish healthcare system aims to provide equal access to care to all residents yet evidence suggests that patients with low socioeconomic status are less likely to receive new treatments.


To our knowledge, this relationship has not previously been investigated in Sweden, and findings may be relevant for other currently available new drugs/treatments compared with the standard of care. Our study suggests the existence of socioeconomic and demographic inequalities in use of NOACs for stroke prevention in Swedish patients with NVAF. Further research is needed to explore reasons for such inequalities in NOAC treatment in a health system that aims to ensure equity to all citizens. Lines of investigation should focus on the role of patient groups, providers and other healthcare system factors in the prescription of anticoagulants in Sweden. Physicians’ early adoption of new drugs, preferential prescribing, susceptibility to patient demands and physician specialty in prescribing anticoagulants, all need to be investigated. Examination of country-specific treatment guidelines and incentive programs, and patient preferences are also worthy lines of investigation.

Pareen Vora
Bayer AG

Read the Original

This page is a summary of: Sociodemographic factors and choice of oral anticoagulant in patients with non-valvular atrial fibrillation in Sweden: a population-based cross-sectional study using data from national registers, BMC Cardiovascular Disorders, February 2019, Springer Science + Business Media, DOI: 10.1186/s12872-019-1029-z.
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