Key result
ABC pathway adherence linked to ~61% lower 1-year major cardiovascular events in high-risk AF.
Why the study?
Patients with AF at high risk of both thrombotic and haemorrhagic events represent a heterogeneous clinical entity with Janus-faced risk factors, requiring phenotypic characterization and assessment of ABC pathway adherence.
Does adherence to the ABC pathway reduce adverse clinical events in patients with atrial fibrillation at high risk of bleeding and stroke?
Cohort (n=2,535)
Yes
Does adherence to the ABC pathway reduce adverse clinical events in patients with atrial fibrillation at high risk of bleeding and stroke?
Answers are grounded in this paper and cite their sources.
In high-risk patients with atrial fibrillation, adherence to the ABC pathway is associated with significantly lower odds of 1-year MACE, and distinct phenotypic clusters can predict mortality risk.
BACKGROUND: Patients with atrial fibrillation (AF) who are at increased risk of both thrombotic and haemorrhagic events represent a heterogeneous and broad clinical entity, characterized by the presence of several Janus-faced risk factors. We aimed to identify clinical phenotypes and assess the association of ABC pathway adherence with one-year outcomes in patients with AF at high risk of both stroke and bleeding. Hierarchical clustering was applied to identify phenotypic subgroups. We assessed the impact on net adverse clinical event (NACE) of adherence to the integrated care based on the Atrial fibrillation Better Care (ABC) pathway. RESULTS: A total of 2,535 patients (mean age 75.4 ± 7.8 years; 58.3% male) were enrolled. Cluster I had the highest rates of prior thromboembolic and haemorrhagic events with the lowest comorbidity burden; Cluster II comprised the oldest patients with the highest prevalence of dyslipidaemia, heart failure, and peripheral artery disease; Cluster III was the youngest with the highest BMI and alcohol use. Cluster II (aOR 1.93, 95% CI 1.37-2.78), and Cluster III (aOR 1.65, 95% CI 1.10-2.50) were associated with a higher risk of all-cause death compared to Cluster I. Among patients with available ABC pathway data, adherence was associated with lower odds of 1-year MACE (OR 0.39, 95% CI 0.15-0.82). CONCLUSION: Three distinct phenotypic clusters were identified, each with heterogeneous clinical characteristics and outcomes, underscoring the need for more individualised, phenotype-informed management strategies in this complex patient population.
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Askarinejad et al. (2026) conducted a cohort in Atrial fibrillation at high risk of bleeding and stroke (n=2,535). Adherence to the Atrial fibrillation Better Care (ABC) pathway vs. Non-adherence was evaluated on 1-year MACE (OR 0.39, 95% CI 0.15-0.82). Adherence to the Atrial fibrillation Better Care (ABC) pathway was associated with lower odds of 1-year major cardiovascular events in high-risk patients with atrial fibrillation.
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