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
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Key result
Adherence to the ABC pathway in clinically complex patients with atrial fibrillation reduced the risk of all-cause death by 28% (aHR 0.72) compared to non-adherence.
Why the study?
Clinical complexity is increasingly prevalent in AF, but limited data exist regarding the usefulness of the Atrial fibrillation Better Care (ABC) pathway in clinically complex patients.
Does adherence to the ABC pathway reduce the risk of major adverse events in clinically complex patients with atrial fibrillation?
Population
8289 clinically complex AF patients from 9966 total patients in the ESC-EHRA EORP-AF registry
Comparison
Adherence to the ABC pathway vs non-adherence
Design
Registry-based cohort study
Authors
Discussion
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Implication
ABC adherence was associated with fewer deaths and MACEs in complex AF; leaves open whether implementation improves outcomes pending trials.
Study Design
Type
Observational (n=9,966)
Multicenter
Yes
Structured PICO
Does adherence to the ABC pathway reduce the risk of major adverse events in clinically complex patients with atrial fibrillation?
P
Population
9,966 patients aged 18 and older with atrial fibrillation, including 8,289 clinically complex patients (frailty, multimorbidity, and/or polypharmacy), followed for a median of 730 days.
E
Exposure
Adherence to the Atrial fibrillation Better Care (ABC) pathway (A: Anticoagulation/avoid stroke; B: Better symptom management; C: Cardiovascular risk factors and Comorbidities optimization).
C
Comparator
Non-adherence to the ABC pathway (or adherence to fewer criteria).
O
Outcome
All-cause death, major adverse cardiovascular events (MACEs: composite of any thromboembolic events, any acute coronary syndrome, and cardiovascular death), and a composite outcome of all-cause death and MACE at median 730 days follow-up.composite
Main Result
Hazard Ratio: 0.72 (95% CI 0.58–0.91)
Number Needed to Treat: 24
Adherence to the holistic ABC pathway significantly improves survival and reduces cardiovascular events in clinically complex patients with atrial fibrillation.
Limitations
- Observational design
- Limited power to evaluate subgroups that were not specified in the original study design
- Potential unaccounted bias
- Cohort established across European countries and may not completely reflect other AF populations
Cite This Study
Romiti et al. (2022) conducted an observational in Atrial fibrillation (n=9,966). Adherence to the Atrial fibrillation Better Care (ABC) pathway vs. Non-adherence to the ABC pathway was evaluated on All-cause death (aHR 0.72, 95% CI 0.58-0.91). Adherence to the ABC pathway in clinically complex patients with atrial fibrillation reduced the risk of all-cause death by 28% (aHR 0.72) compared to non-adherence.
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