Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Giulio Francesco Romiti, Marco Proietti, Marco Vitolo, Niccolò Bonini, Ameenathul Mazaya Fawzy, Wern Yew Ding, Laurent Fauchier, Francisco Marin, Michael Nabauer, Gheorghe Andrei Dan, Tatjana S. Potpara, Giuseppe Boriani, Gregory Y. H. Lip*, ESC-EHRA EORP-AF General Long-Term Registry Investigators , A. Marni Joensen (Member of study group), A. Gammelmark (Member of study group), L. Hvilsted Rasmussen, P. Dinesen (Member of study group), S. Riahi (Member of study group), S. Krogh Venø (Member of study group)B. Sorensen (Member of study group), A. Korsgaard (Member of study group), K. Andersen (Member of study group), C. Fragtrup Hellum (Member of study group)

*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

BACKGROUND: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The 'Atrial fibrillation Better Care' (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients.

METHODS: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses.

RESULTS: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58-0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52-0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58-0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56-0.98) and composite outcome (aHR: 0.76, 95%CI 0.60-0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome.

CONCLUSIONS: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients.

Original languageEnglish
Article number326
JournalBMC Medicine
Volume20
Issue number1
Pages (from-to)326
Number of pages1
ISSN1741-7015
DOIs
Publication statusPublished - 2 Sept 2022

Bibliographical note

© 2022. The Author(s).

Keywords

  • Anticoagulants/therapeutic use
  • Atrial Fibrillation/drug therapy
  • Humans
  • Registries
  • Risk Factors
  • Stroke/complications
  • Atrial fibrillation
  • Clinical complexity
  • Integrated management
  • Outcomes

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    • Additional file 1 of Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

      Romiti, G. F. (Creator), Proietti, M. (Creator), Vitolo, M. (Creator), Bonini, N. (Creator), Fawzy, A. M. (Creator), Ding, W. Y. (Creator), Fauchier, L. (Creator), Marin, F. (Creator), Nabauer, M. (Creator), Dan, G. A. (Creator), Potpara, T. S. (Creator), Boriani, G. (Creator) & Lip, G. Y. H. (Creator), Figshare, 2 Sept 2022

      DOI: 10.6084/m9.figshare.20882207.v1, https://springernature.figshare.com/articles/journal_contribution/Additional_file_1_of_Clinical_complexity_and_impact_of_the_ABC_Atrial_fibrillation_Better_Care_pathway_in_patients_with_atrial_fibrillation_a_report_from_the_ESC-EHRA_EURObservational_Research_Programme_in_AF_General_Long-Term_Registry/20882207/1

      Dataset: Supplementary material

    • Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

      Romiti, G. F. (Creator), Proietti, M. (Creator), Vitolo, M. (Creator), Bonini, N. (Creator), Fawzy, A. M. (Creator), Ding, W. Y. (Creator), Fauchier, L. (Creator), Marin, F. (Creator), Nabauer, M. (Creator), Dan, G. A. (Creator), Potpara, T. S. (Creator), Boriani, G. (Creator), Lip, G. Y. H. (Creator), Tavazzi, L. (Contributor), Maggioni, A. P. (Contributor), Kalarus, Z. (Contributor), Ferrari, R. (Contributor), Shantsila, A. (Contributor), Goda, A. (Contributor), Mairesse, G. (Contributor), Shalganov, T. (Contributor), Antoniades, L. (Contributor), Taborsky, M. (Contributor), Riahi, S. (Contributor), Muda, P. (Contributor), García Bolao, B. I. (Contributor), Piot, O. (Contributor), Etsadashvili, K. (Contributor), Simantirakis, E. N. (Contributor), Haim, M. (Contributor), Azhari, A. (Contributor), Najafian, J. (Contributor), Santini, M. (Contributor), Mirrakhimov, E. (Contributor), Kulzida, K. (Contributor), Erglis, A. (Contributor), Poposka, L. (Contributor), Burg, M. R. 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      DOI: 10.6084/m9.figshare.c.6180596, https://springernature.figshare.com/collections/Clinical_complexity_and_impact_of_the_ABC_Atrial_fibrillation_Better_Care_pathway_in_patients_with_atrial_fibrillation_a_report_from_the_ESC-EHRA_EURObservational_Research_Programme_in_AF_General_Long-Term_Registry/6180596

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