Key result
ABC pathway adherence shows no benefit for major adverse outcomes in care home AF residents.
Why the study?
The ABC pathway is the gold-standard approach to AF management, but the effect of its implementation on health outcomes in care home residents is unknown.
Does adherence to the ABC pathway reduce adverse health outcomes in older care home residents with atrial fibrillation?
Cohort (n=14,493)
Does adherence to the ABC pathway reduce adverse health outcomes in older care home residents with atrial fibrillation?
Hazard Ratio: 1.01 (95% CI 0.97–1.05)
Absolute Event Rate: 82.1% vs 90.7%
p-value: p=0.588
In older care home residents with AF, adherence to the ABC pathway using routinely collected data definitions did not reduce the risk of composite adverse clinical outcomes, challenging a standardized treatment approach in this frail population.
ABC pathway adherence was not associated with lower composite risk in frail AF residents; leaves open whether tailored definitions warrant prospective testing before practice consideration.
BACKGROUND: The Atrial fibrillation Better Care (ABC) pathway is the gold-standard approach to atrial fibrillation (AF) management, but the effect of implementation on health outcomes in care home residents is unknown. OBJECTIVE: To examine associations between ABC pathway adherence and stroke, transient ischaemic attack, cardiovascular hospitalisation, major bleeding, mortality and a composite of all these outcomes in care home residents. METHODS: A retrospective cohort study of older care home residents (≥65 years) in Wales with AF was conducted between 1 January 2003 and 31 December 2018 using the Secure Anonymised Information Linkage Databank. Adherence to the ABC pathway was assessed at care home entry using pre-specified definitions. Cox proportional hazard and competing risk models were used to estimate the risk of health outcomes according to ABC adherence. RESULTS: From 14,493 residents (median [interquartile range] age 87.0 [82.6-91.2] years, 35.2% male) with AF, 5,531 (38.2%) were ABC pathway adherent. Pathway adherence was not significantly associated with risk of the composite outcome (adjusted hazard ratio, 95% confidence interval [CI]: 1.01 [0.97-1.05]). There was a significant independent association observed between ABC pathway adherence and a reduced risk of myocardial infarction (0.70 [0.50-0.98]), but a higher risk of haemorrhagic stroke (1.59 [1.06-2.39]). ABC pathway adherence was not significantly associated with any other individual health outcomes examined. CONCLUSION: An ABC adherent approach in care home residents was not consistently associated with improved health outcomes. Findings should be interpreted with caution owing to difficulties in defining pathway adherence using routinely collected data and an individualised approach is recommended.
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Ritchie et al. (2024) conducted a cohort in Atrial fibrillation in older care home residents (n=14,493). Adherence to the Atrial fibrillation Better Care (ABC) pathway vs. Non-adherence to the ABC pathway was evaluated on Composite of stroke, TIA, cardiovascular hospitalisation, major bleeding, myocardial infarction, and all-cause mortality (aHR 1.01, 95% CI 0.97-1.05, p=0.588). Adherence to the ABC pathway did not significantly reduce the risk of composite adverse outcomes compared to non-adherence in older care home residents with atrial fibrillation (aHR 1.01, p=0.588).
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