ABC (Atrial fibrillation Better Care) pathway and healthcare costs in atrial fibrillation. The ATHERO-AF study

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  • Daniele Pastori
  • Alessio Farcomeni
  • Pasquale Pignatelli
  • Francesco Violi
  • Gregory Yh Lip

Abstract

BACKGROUND: The Atrial fibrillation Better Care (ABC) pathway for the integrated approach to the management of patients with atrial fibrillation has been proposed to streamline patient management in an integrated, holistic manner, as follows: 'A' Avoid stroke with Anticoagulation; 'B' Better symptom management, with rate or rhythm control; 'C' Cardiovascular risk and comorbidity management, including lifestyle factors. ABC pathway compliance has been associated with a reduced rate of cardiovascular events compared to non-ABC compliant patients. However, the impact of the ABC pathway on health-related costs has not been evaluated.

METHODS: We performed an exploratory analysis of costs related to cardiovascular events in the ATHERO-AF study, which is a prospective single-center cohort study including atrial fibrillation patients treated with vitamin K antagonists. A Diagnosis-Related Group code provided by the Italian Ministry of Health was assigned to each cardiovascular event by event typology to estimate the relative cost. The analysis was performed by dividing patients according to ABC pathway components.

RESULTS: Overall, the 118 cardiovascular events in the cohort incurred a cost of 1,017,354 euros (1,149,610 USD). The mean total costs were 13,050 (14,747 USD) and 11,218 euros (12,676 USD) for a non-fatal cardiac event or ischaemic stroke, respectively. The highest costs were related to cardiac complications, followed by non-fatal ischaemic stroke and cardiovascular death. Based on the ABC pathway components, the cost-saving was 719 euros (813 USD) per patient-year for patients in group A vs non-A, 703 euros (794 USD) for B vs non-B, 480 euros (542 USD) for C vs non-C and 2776 euros (3,137 USD) for ABC vs non-ABC. The cost per cardiovascular event increased with the number of uncontrolled ABC components: 0-1: 507 euros (573 USD), raising to 965 euros (1,091 USD) for 2 components and to 3,431 euros (3,877 USD) for patients not having any of the three components of the ABC.

CONCLUSIONS: Management of atrial fibrillation patients according to the ABC pathway was associated with significantly lower health-related costs. Application of the ABC pathway as a management strategy may help reduce healthcare costs related to cardiovascular events in this high-risk patient population.

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BACKGROUND: The Atrial fibrillation Better Care (ABC) pathway for the integrated approach to the management of patients with atrial fibrillation has been proposed to streamline patient management in an integrated, holistic manner, as follows: 'A' Avoid stroke with Anticoagulation; 'B' Better symptom management, with rate or rhythm control; 'C' Cardiovascular risk and comorbidity management, including lifestyle factors. ABC pathway compliance has been associated with a reduced rate of cardiovascular events compared to non-ABC compliant patients. However, the impact of the ABC pathway on health-related costs has not been evaluated.

METHODS: We performed an exploratory analysis of costs related to cardiovascular events in the ATHERO-AF study, which is a prospective single-center cohort study including atrial fibrillation patients treated with vitamin K antagonists. A Diagnosis-Related Group code provided by the Italian Ministry of Health was assigned to each cardiovascular event by event typology to estimate the relative cost. The analysis was performed by dividing patients according to ABC pathway components.

RESULTS: Overall, the 118 cardiovascular events in the cohort incurred a cost of 1,017,354 euros (1,149,610 USD). The mean total costs were 13,050 (14,747 USD) and 11,218 euros (12,676 USD) for a non-fatal cardiac event or ischaemic stroke, respectively. The highest costs were related to cardiac complications, followed by non-fatal ischaemic stroke and cardiovascular death. Based on the ABC pathway components, the cost-saving was 719 euros (813 USD) per patient-year for patients in group A vs non-A, 703 euros (794 USD) for B vs non-B, 480 euros (542 USD) for C vs non-C and 2776 euros (3,137 USD) for ABC vs non-ABC. The cost per cardiovascular event increased with the number of uncontrolled ABC components: 0-1: 507 euros (573 USD), raising to 965 euros (1,091 USD) for 2 components and to 3,431 euros (3,877 USD) for patients not having any of the three components of the ABC.

CONCLUSIONS: Management of atrial fibrillation patients according to the ABC pathway was associated with significantly lower health-related costs. Application of the ABC pathway as a management strategy may help reduce healthcare costs related to cardiovascular events in this high-risk patient population.

Original languageEnglish
JournalThe American Journal of Medicine
ISSN0002-9343
DOI
Publication statusE-pub ahead of print - 16 Jan 2019
Publication categoryResearch
Peer-reviewedYes
ID: 294534204