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. 2022 Nov 24:55:101757.
doi: 10.1016/j.eclinm.2022.101757. eCollection 2023 Jan.

Adherence to the Atrial Fibrillation Better Care (ABC) pathway and the risk of major outcomes in patients with atrial fibrillation: A post-hoc analysis from the prospective GLORIA-AF Registry

Giulio Francesco Romiti  1   2 , Marco Proietti  1   3   4 , Niccolò Bonini  1   5 , Wern Yew Ding  1 , Giuseppe Boriani  5 , Menno V Huisman  6 , Gregory Y H Lip  1   7 ; GLORIA-AF Investigators
Affiliations

Adherence to the Atrial Fibrillation Better Care (ABC) pathway and the risk of major outcomes in patients with atrial fibrillation: A post-hoc analysis from the prospective GLORIA-AF Registry

Giulio Francesco Romiti et al. EClinicalMedicine. .

Abstract

Background: The 'Atrial fibrillation Better Care' (ABC) pathway has been proposed to streamline a more holistic or integrated care approach to atrial fibrillation (AF) management. We aimed to analyse the impact of adherence to the ABC pathway on the risk of major adverse outcomes in a contemporary prospective global cohort of patients with AF.

Methods: Patients enrolled Phase II and III of the GLORIA-AF Registry with complete data on ABC pathway adherence and follow-up were included in this post-hoc analysis between November 2011 and December 2014 for Phase II, and between January 2014 and December 2016 for Phase III. The primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACEs). Multivariable Cox-regression and delay of event (DoE) analyses were used to evaluate the association between adherence to the ABC pathway and the risk of outcomes.

Findings: We included 24,608 patients in this analysis (mean age: 70.2 (10.3) years, 10,938 (44.4%) females). Adherence to the ABC pathway was associated with a significant risk reduction for the primary outcome, with greatest magnitude observed for full ABC pathway adherence (adjusted Hazard Ratio [aHR] 0.54, 95% Confidence Interval [CI]: 0.44-0.67, p < 0.0001). ABC pathway adherence was also associated with reduced risk of mortality (aHR: 0.89, 95% CI: 0.79-1.00, p = 0.048), thromboembolism (aHR: 0.78, 95% CI: 0.65-0.94, p = 0.0078), and MACE (aHR: 0.82, 95% CI: 0.71-0.95, p = 0.0071). An increasing number of ABC criteria attained was associated with longer event-free survival in the DoE analysis.

Interpretation: Adherence to the ABC pathway in patients with AF was associated with a reduced risk of major adverse events, including mortality, thromboembolism and MACE. This underlines the importance of using the ABC pathway in the clinical care of patients with AF.

Funding: This study was funded by Boehringer Ingelheim.

Keywords: Atrial fibrillation; Integrated care; Outcomes.

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Conflict of interest statement

G.Y.H.L. has been consultant and speaker for BMS/Pfizer, Boehringer Ingelheim and Daiichi-Sankyo. No fees are directly received personally. All the disclosures happened outside the submitted work. G.B. received small speaker's fees from Medtronic, Boston, Boehringer Ingelheim and Bayer. M.V.H. has been receiving research grants from the Dutch Healthcare Fund, Dutch Heart Foundation, BMS-Pfizer, Bayer Healthcare and Boehringer Ingelheim and consulting fees from BMS-Pfizer, Bayer Healthcare and Boehringer Ingelheim. All other authors have nothing to declare.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves for the primary composite outcome of all-cause death and MACE according to the number of ABC criteria fulfilled. p < 0.001 (Log–Rank test).
Fig. 2
Fig. 2
Pattern of adherence to the ABC pathway and risk of the primary outcome of all-cause death and MACE. Adjusted for age, sex, type of atrial fibrillation, hypertension, diabetes mellitus, chronic heart failure, coronary artery disease, peripheral artery disease, history of stroke/transient ischemic attack. Ref. = Reference group.
Fig. 3
Fig. 3
Pattern of adherence to the ABC pathway and risk of the primary outcome of all-cause death and MACE in patients with at least 1 comorbidity at baseline. Adjusted for age, sex, type of atrial fibrillation, hypertension, diabetes mellitus, chronic heart failure, coronary artery disease, peripheral artery disease, history of stroke/transient ischemic attack. Ref. = Reference group.
See this image and copyright information in PMC

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