Key result
Compliance with the ABC pathway in high frailty risk atrial fibrillation patients was associated with lower all-cause death compared to non-compliance (6.5 vs 17.5 per 100 person-years; HR 0.74; P<0.001).
Why the study?
The benefit of integrated care management using the ABC pathway was unknown in frail AF patients.
Does compliance with the ABC pathway improve clinical outcomes in frail patients with nonvalvular atrial fibrillation?
Cohort (n=262,987)
Yes
Does compliance with the ABC pathway improve clinical outcomes in frail patients with nonvalvular atrial fibrillation?
Hazard Ratio: 0.74 (95% CI 0.56–0.97)
Absolute Event Rate: 6.5% vs 17.5%
p-value: p=<.001
Compliance with the ABC pathway for integrated care management is associated with reduced all-cause mortality in nonvalvular atrial fibrillation patients with high frailty risk.
ABC pathway associated with lower mortality in high-frailty AF; leaves open confirmation in randomized trials.
Background The benefit of integrated care management was unknown in frail atrial fibrillation (AF) patients. This study evaluated whether compliance with the atrial fibrillation Better Care (ABC) pathway for integrated care management would improve clinical outcomes in frail AF patients. Methods From the Korea National Health Insurance Service database, 262,987 nonvalvular AF patients were enrolled between 1 January 2005 and 31 December 2015. For each patient, the Hospital Frailty Risk Score and category were calculated retrospectively using all available ICD‐10 diagnostic codes. Patients were divided into three frailty‐based risk categories: low (<5 points, n = 221,542), intermediate (5‐15 points, n = 37,341), and high risk (>15 points, n = 4,104). Results Over a mean follow‐up of 5.9 (interquartile range 3.2, 9.4) years, in high frailty risk patients, the ABC group had lower rates of all‐cause death (6.5 vs 17.5 per 100 person‐years, P < .001; hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.56‐0.97) but was nonsignificant for the composite outcome (10.5 vs 26.0 per 100 person‐years, P = .101; HR 0.79; 95% CI 0.59‐1.05) compared with the Non‐ABC group. When the three frailty categories were compared, the greatest benefit on mortality was seen in the high frailty group (p int < 0.001), but for the composite outcome, there was no statistical interaction for the three frailty categories (p int = 0.063). Conclusions Compliance with the simple ABC pathway is associated with improved outcomes in AF patients with high frailty risk. Given the high healthcare burden associated with frail AF patients, integrated AF management should be implemented to improve outcomes in these patients.
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Yang et al. (2020) conducted a cohort in Nonvalvular atrial fibrillation (n=262,987). Compliance with the atrial fibrillation Better Care (ABC) pathway vs. Non-ABC group (non-compliance) was evaluated on All-cause death in high frailty risk patients (HR 0.74, 95% CI 0.56-0.97, p=<.001). Compliance with the ABC pathway in high frailty risk atrial fibrillation patients was associated with lower all-cause death compared to non-compliance (6.5 vs 17.5 per 100 person-years; HR 0.74; P<0.001).
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