Key result
Adherence to the ABC pathway was associated with a 36% reduced risk of the composite outcome of all-cause mortality and major adverse cardiovascular events (HR 0.64) in patients with atrial fibrillation.
Why the study?
Limited data exist on the effectiveness of the ABC pathway in reducing adverse events in Asian patients with AF and CKD.
Does adherence to the ABC pathway reduce the composite outcome of all-cause mortality and MACE in Asian patients with atrial fibrillation and chronic kidney disease?
Cohort (n=3,550)
Yes
Does adherence to the ABC pathway reduce the composite outcome of all-cause mortality and MACE in Asian patients with atrial fibrillation and chronic kidney disease?
Hazard Ratio: 0.64 (95% CI 0.48–0.87)
In Asian patients with atrial fibrillation, adherence to the ABC pathway is associated with a significantly lower risk of adverse cardiovascular events and mortality, even in the presence of chronic kidney disease.
Extends ABC pathway evidence to Asian AF-CKD patients; hypothesis-generating and requires randomized confirmation.
Background: Limited data exist on the effectiveness of the ABC (Atrial Fibrillation Better Care) pathway in reducing adverse events in Asian patients with atrial fibrillation (AF) and chronic kidney disease (CKD). Methods: A post-hoc analysis of the prospective APHRS AF Registry. Patients were divided into CKD (eGFR < 60 ml/min) and non-CKD (eGFR ≥ 60 ml/min) groups. Logistic regression assessed factors associated with CKD, oral anticoagulant (OAC) use, and rhythm control strategies. Cox regression estimated hazard ratios (HRs) for a composite outcome of all-cause mortality and major adverse cardiovascular events. Subgroup analyses evaluated outcomes by CKD severity and ABC adherence. Findings: Of 3550 patients, 1029 had CKD (mean age 75.3 ± 10.3 years, 40.3% female), and 2521 did not (66.4 ± 11.3 years, 32.3% female). CKD patients were older, more often female, had lower ABC adherence (29.5% vs. 42.1%, p < 0.001) and anticoagulation use (Odds Ratio [OR] 0.77, 95% CI 0.61-0.96), but higher warfarin use, and were less likely to receive rhythm control (OR 0.79, 95% CI 0.66-0.94) comparing to those without CKD. CKD and adherence to the ABC pathway were independently associated with higher (HR 1.90, 95% CI 1.46-2.48) and lower (HR 0.64, 95% CI 0.48-0.87) risks of the composite outcome, respectively. Adverse event risks increased with CKD severity, and ABC pathway benefits were observed irrespective of CKD. Interpretation: AF patients with CKD show lower ABC pathway adherence and high risk of adverse events. Improving adherence to integrated care approaches may improve prognosis in this patient group. Funding: This study was an independent research grant by Pfizer and Bristol Myers Squibb (BMS) to APHRS.
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Bucci et al. (2025) conducted a cohort in Atrial fibrillation and chronic kidney disease (n=3,550). Adherence to the ABC pathway vs. Non-adherence to the ABC pathway was evaluated on Composite of all-cause death and major adverse cardiovascular events (MACE) (HR 0.64, 95% CI 0.48-0.87). Adherence to the ABC pathway was associated with a 36% reduced risk of the composite outcome of all-cause mortality and major adverse cardiovascular events (HR 0.64) in patients with atrial fibrillation.
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