Key result
Only 28% of patients with atrial fibrillation were adherent to the ABC pathway, with age >75 years and poor blood pressure control inversely associated with adherence.
Why the study?
The Atrial Fibrillation Better Care pathway improves AF management and outcomes, but adherence has been found to be suboptimal across studies.
Does adherence to the ABC pathway improve clinical outcomes in patients with atrial fibrillation?
Cohort (n=322)
Yes
Does adherence to the ABC pathway improve clinical outcomes in patients with atrial fibrillation?
Adherence to the recommended ABC pathway for atrial fibrillation management remains suboptimal in clinical practice, highlighting a gap in guideline implementation.
Suboptimal ABC adherence in AF should not yet change practice; leaves open whether improving it enhances outcomes in real-world cohorts.
Introduction The Atrial Fibrillation Better Care (ABC) pathway was introduced to improve the management of patients with atrial fibrillation (AF) thus improving their outcomes. However, adherence to the ABC pathway has been found to be suboptimal in many studies. Objective To investigate the prevalence and factors associated with adherence to the ABC pathway, and subsequent adverse clinical event. Methods Patients with AF from two cardiology centers within June 2020 to December 2022 were included in this retrospective cohort study. Adherence to "A": optimal time in therapeutic range (TTR) > 65 % for warfarin therapy and appropriate dosage of non-vitamin K antagonist oral anticoagulants (NOACs) prescribed, "B": attainment of an European Heart Rhythm Association (EHRA) score 1–2 and "C": appropriate management of underlying cardiovascular (CV) disease. Thromboembolic (TE) event is defined as suffering ≥1 stroke and/or transient ischemic attack. Results A total of 322 AF patients [mean age: 70 ± 12 years; 47.5 % female] were followed for a mean 22 ± 1 months. Only 90 (28 %) patients were managed according to the ABC pathway while 232 (72 %) patients were non-adherent to the ABC pathway. Adherence to A, B and C, and overall ABC pathway was observed in 227 (70.5 %), 321 (99.7 %), 128 (39.8 %) and 90 (28 %) patients respectively. After adjustment, age >75 years, poor blood pressure control were inversely associated with ABC adherent whereas optimal TTR was associated with ABC adherent. There were 7 cases of TE and 9 all-cause mortality during follow up. Conclusion The study found suboptimal adherence to the ABC pathway in AF patients with a select few risk factors (optimal TTR), displaying unique relationships between ABC pathway adherence. The study will pave the way for further understanding on how clinicians perceive the recommended ABC pathway.
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Osman et al. (2025) conducted a cohort in Atrial fibrillation (n=322). Adherence to the ABC pathway vs. Non-adherence to the ABC pathway was evaluated on Adherence to the ABC pathway and adverse clinical events (thromboembolic events and all-cause mortality). Only 28% of patients with atrial fibrillation were adherent to the ABC pathway, with age >75 years and poor blood pressure control inversely associated with adherence.
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