Demographic and clinical data were collected from MHS and Israel’s ministry of health databases. Baseline comorbidities and risk score calculations were obtained from MHS patient registries, described previously [21, 22] and included: age, sex, socioeconomic status (SES), smoking status, hypertension, diabetes mellitus, peripheral vascular disease (PVD), ischemic heart disease (IHD) with or without a history of myocardial infarction (MI), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), previous stroke or transient ischemic attack (TIA). The CHA2DS2-VASc score was calculated for all patients by assigning 2 points for age≥75 years (A2) and history of stroke, TIA, or thromboembolism (S2) and 1 point for each of the following criteria: CHF (C), hypertension (H), diabetes mellitus (D), age 65 to 75 years (A), vascular disease (VA) (defined as previous myocardial infarction, complex aortic plaque, carotid stenosis, and peripheral artery disease) and female sex category (Sc). Data regarding medical therapy (at least 2 dispensed packs during 120 days before index date) were obtained and classified according to the following therapeutic agents: angiotensin-converting enzyme inhibitors (ACE-i), angiotensin receptor blockers (ARBs), alpha-blockers, beta-blockers, calcium channel blockers, digoxin, diuretics, heparins, nitrates, antiplatelets, and vasodilators.

Dates of death or leaving the health maintenance organization (HMO) are reported to MHS daily from the Israel National Insurance Institute. Residential area SES level was based on a commercial index (developed by Points Location Intelligence) ranging from 1 (lowest) to 10 (highest). Scoring is conducted according to various socioeconomic indices (e.g. credit card use information, housing prices, education level, etc.) and was previously shown to highly correlate with the SES index provided by Israel’s National Bureau of Statistics [23].

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