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. 2022 Sep 2;20(1):326.
doi: 10.1186/s12916-022-02526-7.

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

Giulio Francesco Romiti #  1   2 , Marco Proietti #  1   3   4 , Marco Vitolo  1   5   6 , Niccolò Bonini  1   5 , Ameenathul Mazaya Fawzy  1 , Wern Yew Ding  1 , Laurent Fauchier  7 , Francisco Marin  8 , Michael Nabauer  9 , Gheorghe Andrei Dan  10 , Tatjana S Potpara  11   12 , Giuseppe Boriani #  5 , Gregory Y H Lip #  13   14 ; ESC-EHRA EORP-AF General Long-Term Registry Investigators
Collaborators, Affiliations

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

Giulio Francesco Romiti et al. BMC Med. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Atrial fibrillation; Clinical complexity; Integrated management; Outcomes.

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Conflict of interest statement

MP is an investigator of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 899871. LF has been a consultant and speaker for AstraZeneca, Bayer, BMS/Pfizer, Boehringer Ingelheim, Medtronic, Novartis, Novo, XO and Zoll. FM is a consultant for Bayer and Boehringer-Ingelheim; FM received small research’s fees from AFNET, Ferrer, Astra-Zeneca, Boehringer-Ingelheim and Bayer; FM is an investigator of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 899871. TSP is a consultant for Bayer and Pfizer, with no fees received personally; GB a received small speaker’s fees from Medtronic, Boston, Boehringer Ingelheim and Bayer; GYHL is a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim and Daiichi-Sankyo. No fees are received personally. GYHL is co-principal investigator of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 899871.

Figures

Fig. 1
Fig. 1
Kaplan Meier Curves for the risk of all-cause death according to cluster analysis. Legend: p-value for log-rank test
Fig. 2
Fig. 2
Delay of event analysis for all-cause death, ABC adherent vs. non-adherent in high-complexity cluster subgroup. Legend: DoE, delay of event. Figures reported are estimates [95% confidence intervals]
Fig. 3
Fig. 3
Central Illustration (Created with Biorender.com)
See this image and copyright information in PMC

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