Adherence to the "Atrial fibrillation Better Care" (ABC) pathway in patients with atrial fibrillation and cancer: A report from the ESC-EHRA EURObservational Research Programme in atrial fibrillation (EORP-AF) General Long-Term Registry

Marco Vitolo, Marco Proietti, Vincenzo L. Malavasi, Niccolo' Bonini, Giulio Francesco Romiti, Jacopo F. Imberti, Laurent Fauchier, Francisco Marin, Michael Nabauer, Tatjana S. Potpara, Gheorghe-Andrei Dan, Zbigniew Kalarus, Aldo Pietro Maggioni, Deirdre A. Lane, Gregory Y. H. Lip, Giuseppe Boriani*, ESC-EHRA EORP-AF Long-Term General Registry Investigators, Albert Marni Joensen (Member of study group), Anders Gammelmark (Member of study group), Lars Hvilsted Rasmussen (Member of study group)Pia Thisted Dinesen (Member of study group), Sam Riahi (Member of study group), Stine Krogh Venø (Member of study group), Bodil Ginnerup Sørensen (Member of study group), Anne Marie Korsgaard (Member of study group), Karen Petrea Andersen (Member of study group), Camilla Fragtrup Hellum (Member of study group)

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

19 Citations (Scopus)

Abstract

Background: Implementation of the Atrial fibrillation Better Care (ABC) pathway is recommended by guidelines on atrial fibrillation (AF), but the impact of adherence to ABC pathway in patients with cancer is unknown. Objectives: To investigate the adherence to ABC pathway and its impact on adverse outcomes in AF patients with cancer. Methods: Patients enrolled in the EORP-AF General Long-Term Registry were analyzed according to (i) No Cancer; and (ii) Prior or active cancer and stratified in relation to adherence to the ABC pathway. The composite Net Clinical Outcome (NCO) of all-cause death, major adverse cardiovascular events and major bleeding was the primary endpoint. Results: Among 6550 patients (median age 69 years, females 40.1%), 6005 (91.7%) had no cancer, while 545 (8.3%) had a diagnosis of active or prior cancer at baseline, with the proportions of full adherence to ABC pathway of 30.6% and 25.7%, respectively. Adherence to the ABC pathway was associated with a significantly lower occurrence of the primary outcome vs. non-adherence, both in ‘no cancer’ and ‘cancer’ patients [adjusted Hazard Ratio (aHR) 0.78, 95% confidence interval (CI): 0.66–0.92 and aHR 0.59, 95% CI 0.37–0.96, respectively]. Adherence to a higher number of ABC criteria was associated with a lower risk of the primary outcome, being lowest when 3 ABC criteria were fulfilled (no cancer: aHR 0.54, 95%CI: 0.36–0.81; with cancer: aHR 0.32, 95% CI 0.13–0.78). Conclusion: In AF patients with cancer enrolled in the EORP-AF General Long-Term Registry, adherence to ABC pathway was sub-optimal.

Original languageEnglish
JournalEuropean Journal of Internal Medicine
Volume105
Pages (from-to)54-62
Number of pages9
ISSN0953-6205
DOIs
Publication statusPublished - Nov 2022

Bibliographical note

Copyright © 2022. Published by Elsevier B.V.

Keywords

  • Atrial fibrillation
  • Cancer
  • Integrated care
  • Mortality
  • Outcomes
  • Stroke

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