Publications by authors named "Mika Lehto"
Background And Objectives: Psychosocial stress is a potentially modifiable risk factor of early-onset ischemic stroke, with limited evidence suggesting a stronger association between stress and cryptogenic ischemic stroke (CIS) compared with strokes of known etiology. We aimed to explore the association between self-perceived stress and CIS, with subgroup analyses stratified by sex and age.
Methods: Young patients aged 18-49 years with a first-ever CIS and sex-matched and age-matched stroke-free controls from 19 European centers were included.
Background: Patients with atrial fibrillation (AF) are often treated with antiarrhythmic drugs (AADs) to maintain sinus rhythm and with heart rate-lowering drugs to achieve the optimal rate control. In this study, we investigated trends in the use of AADs and rate control drugs in Finnish patients with AF.
Methods And Results: The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study is a nationwide study including all patients with AF in Finland from 2007 to 2018.
Objective: Patients with alcohol use disorders (AUD) often receive inferior care for somatic comorbidities. Our objective was to explore whether AUDs influence oral anticoagulant (OAC) initiation for stroke prevention among atrial fibrillation (AF) patients, using a nationwide dataset to assess treatment disparities.
Methods: The Finnish AntiCoagulation in Atrial Fibrillation registry includes data on all 229,565 patients diagnosed with incident AF in Finland during 2007-2018, identified from national registries covering all levels of care.
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.
Objectives: This study sought to investigate temporal trends in IS rates in patients with incident AF before oral anticoagulant agent (OAC) therapy.
Methods: The nationwide FinACAF (Finnish Anticoagulation in Atrial Fibrillation) study covers patients with AF at all levels of care in Finland from 2007 to 2018.
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 in catheter ablation procedures for AF, AFL and AVN in Finland between 2012-2018.
Methods: Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) is a registry-based study including all patients with AF or AFL in Finland between 2012-2018.
Article Synopsis
- Atrial fibrillation (AF) patients often need rhythm control therapy, and the study explored whether there are gender disparities in the use of antiarrhythmic therapies (AATs) among these patients in Finland from 2007-2018.
- Out of 229,565 patients studied, women were older, had different health profiles compared to men, and were treated with AATs less frequently, with 17.6% of women and 25.1% of men receiving treatment.
- Interestingly, while women received antiarrhythmic drugs more often across all ages, they underwent fewer cardioversion and ablation procedures, especially those under 65 years old.
Background And Aims: We examined temporal trends and age-related differences in the prevalence of vascular diseases and in their association with ischemic stroke (IS) risk in patients with atrial fibrillation (AF).
Methods: The registry-based FinACAF study covered all patients with AF in Finland during 2007-2018. Incidence rate ratios (IRRs) of IS were computed with Poisson regression, and the interaction of vascular diseases with age and calendar year period was assessed.
Objectives: Atrial fibrillation (AF) is associated with increased mortality. Previous studies have reported conflicting results in temporal trends of mortality after AF diagnosis. We aim to address this disparity by investigating the 1-year mortality and causes of death in Finnish patients diagnosed with AF between 2010 and 2017.
View Article and Find Full Text PDFBackground: How GP continuity of care (GP-CoC) affects mortality in patients with type 2 diabetes (T2D) is unclear.
Aim: To examine the effect of having no continuity of care (CoC) and GP-CoC on mortality in primary health care (PHC) patients with T2D.
Design & Setting: A cohort study in patients aged ≥60 years with T2D, which was conducted within the public PHC of the city of Vantaa, Finland.
Article Synopsis
- The study analyzed changes in the predictive value of a risk score (CHADS-VA) for ischaemic stroke in patients with atrial fibrillation (AF) in Finland from 2007 to 2018.
- Researchers found that early on, the CHADS-VA score was less effective than the CHADS-VASc score, but this changed over time, with CHADS-VA performing better by the end of the study.
- The results suggest that as the risk associated with female sex decreased, the CHADS-VA score gained relevance, indicating a need to adapt stroke risk assessments over time.
Article Synopsis
- The study focused on the prevalence and associated factors of carotid atherosclerosis in stroke patients with atrial fibrillation (AF), finding that 34.6% of patients had this condition.
- Among 2,955 patients analyzed, 6.9% had carotid stenosis of 50% or more, and 5.7% experienced carotid occlusion, with age and previous vascular conditions being significant risk factors.
- The research concluded that atherosclerosis in multiple arterial beds is a strong predictor of significant carotid stenosis, indicating a high level of cardiovascular risk in these patients.
Background: Incidence of cryptogenic ischemic stroke (CIS) in young adults is increasing. Early left atrial (LA) myopathy might be 1 of the underlying mechanisms, but this has only been scarcely explored.
Objectives: The purpose of this study was to assess the association between increased LA stiffness and CIS in young adults.
Article Synopsis
- The study examined the link between heavy alcohol use and young-onset cryptogenic ischemic stroke (CIS) in individuals aged 18-49.
- Patients showed significantly higher rates of heavy drinking compared to stroke-free controls, with 13.7% of CIS patients classified as heavy alcohol users versus 6.7% of controls.
- The findings suggest that heavy alcohol consumption, especially binge drinking, is an independent risk factor for CIS in young men, but not in women.
Background: It can be impossible to assign a definitive diagnosis for symptoms reported or observed by primary health care patients. In these situations, symptomatic diagnoses are often used.
Aim: The aim of the present study was to examine the proportion of symptomatic diagnoses among primary health care patients.
Article Synopsis
- The study investigates how time-in-therapeutic-range (TTR) impacts the effectiveness and safety of warfarin compared to direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF).
- Researchers analyzed data from a nationwide Finnish study between 2011 and 2018, using hazard ratios to assess risks of ischaemic stroke, intracranial hemorrhage, and mortality among patients using warfarin and different DOACs.
- Results indicated that lower TTR was associated with higher risks of complications and mortality in warfarin users, while differences in outcomes between high TTR groups and standard dose DOACs were minimal.
Who visits primary health care general practitioners and why? A register-based study in a Finnish city.
Int J Circumpolar Health
December 2024
This is a register-based study that examines the distribution of diagnoses made by general practitioners (GPs) in the public primary health care of the city of Vantaa, Finland. Data were gathered from the electronic health record (EHR) system and consisted of every record entered into the EHR system between 1 January 2016 and 31 December 2018. Both absolute numbers and relative proportions of the 10 edition of International Classification of Diseases (ICD-10) diagnosis recordings were reported and calculated.
View Article and Find Full Text PDFIntroduction: 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.
View Article and Find Full Text PDFAims: 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 a large AF population.
View Article and Find Full Text PDFBackground 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 2007 to 2018. Ischaemic stroke rates and rate ratios were computed.
Atrial fibrillation (AF) is the most common sustained arrythmia and one of the strongest risk factors and causal mechanisms of ischemic stroke (IS). Acute IS due to AF tends to be more severe than with other etiology of IS and patients with treated AF have reported to experience worse outcomes after endovascular treatment compared with patients without AF. As cardioembolism accounts for more than a fifth of ISs and the risk of future stroke can be mitigated with effective anticoagulation, which has been shown to be effective and safe in patients with paroxysmal or sustained AF, the screening of patients with cryptogenic IS (CIS) for AF is paramount.
View Article and Find Full Text PDFBackground: 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 associated with AF (ISTAF) was defined as an ischemic stroke occurring within ±30 days from the first AF diagnosis.
Myocardial infarction (MI) and atrial fibrillation (AF) are commonly seen in the same patient. In this study, we evaluated the temporal relations and prognosis of MI and AF. This is a substudy of the nationwide registry-based Finnish Anticoagulation in Atrial Fibrillation (FinACAF) study, comprising all Finnish patients with new-onset AF from 2010 to 2017.
View Article and Find Full Text PDFObjectives: We studied association of laboratory testing beyond the international normalised ratio (INR) with bleeding and stroke/transient ischaemic attack (TIA) outcomes in patients with atrial fibrillation treated with warfarin.
Design: This was a retrospective nested case-control study from the Finnish Warfarin in Atrial Fibrillation (FinWAF) registry (n=54 568), reporting the management and outcome in warfarin-anticoagulated patients. Associations of blood count test frequency and results were assessed together with risk of bleeding or stroke/TIA during 5-year follow-up.
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 2018. The primary outcome was the initiation of any OAC therapy.