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Romiti, Giulio Francesco; Proietti, Marco; Vitolo, Marco; Bonini, Niccolò; Fawzy, Ameenathul Mazaya; Ding, Wern Yew; Fauchier, Laurent; Marin, Francisco; Nabauer, Michael; Dan, Gheorghe Andrei; Potpara, Tatjana S.; Boriani, Giuseppe; Lip, Gregory Y. H.; Tavazzi, L.; Maggioni, A. P.; Kalarus, Z.; Ferrari, R.; Shantsila, A.; Goda, A.; Mairesse, G.; Shalganov, T.; Antoniades, L.; Taborsky, M.; Riahi, S.; [...]

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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  • Medientyp: E-Artikel
  • Titel: 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
  • Beteiligte: Romiti, Giulio Francesco; Proietti, Marco; Vitolo, Marco; Bonini, Niccolò; Fawzy, Ameenathul Mazaya; Ding, Wern Yew; Fauchier, Laurent; Marin, Francisco; Nabauer, Michael; Dan, Gheorghe Andrei; Potpara, Tatjana S.; Boriani, Giuseppe; Lip, Gregory Y. H.; Tavazzi, L.; Maggioni, A. P.; Kalarus, Z.; Ferrari, R.; Shantsila, A.; Goda, A.; Mairesse, G.; Shalganov, T.; Antoniades, L.; Taborsky, M.; Riahi, S.; [...]
  • Erschienen: Springer Science and Business Media LLC, 2022
  • Erschienen in: BMC Medicine
  • Sprache: Englisch
  • DOI: 10.1186/s12916-022-02526-7
  • ISSN: 1741-7015
  • Schlagwörter: General Medicine
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients.</jats:p> </jats:sec>
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