The ‘Atrial Fibrillation Better Care’ Pathway for Integrated Care of Atrial Fibrillation: A Systematic Review and Meta-Analysis
Giulio Francesco Romiti, Bernadette Corica, Tommaso Bucci, José Miguel Rivera‐Caravaca, Francisco Marín, Lars Frost, George-Andrei Dan, Tatjana S. Potpara, Mariya Tokmakova, Aldo Pietro Maggioni, Søren Paaske Johnsen, Deirdre Lane, Gregory YH Lip, Marco Proietti, AF-COMET Collaborative Group
Abstract
To conduct an updated systematic review of the current evidence on the implementation of the ‘Atrial fibrillation Better Care’ (ABC) pathway for the comprehensive and holistic management of patients with Atrial Fibrillation (AF). We performed a systematic review and meta-analysis, searching MEDLINE and EMBASE for studies reporting the prevalence of ABC-adherent management in patients with AF and its association with clinical outcomes (all-cause death, cardiovascular death, stroke, stroke/thromboembolism (TE), and major bleeding). Random-effects models were used to pool results from individual studies; subgroup analyses and meta-regressions were also conducted. Overall, 22 studies were included (including 2 randomised trials), with >380,000 AF patients. Adherence to the ABC pathway was 23.9% (95%CI: 17.5%-31.7%), with substantial between-study heterogeneity (I2: 99.8%). Adherence was higher in European cohorts (37.9%, 95%CI: 27.8%-49.2%) and increased with advancing age. ABC pathway adherence was associated with a lower risk of all-cause death (Odds Ratio [OR]: 0.49, 95%CI: 0.41-0.58, I²: 97.1%), cardiovascular death (OR: 0.46, 95%CI: 0.36-0.59, I²: 96.4%), stroke (OR: 0.65, 95%CI: 0.51-0.82, I²: 93.5%), stroke/TE (OR: 0.53, 95%CI: 0.42-0.66, I²: 91.1%) and major bleeding (OR: 0.81, 95%CI: 0.69-0.94, I²: 89.2%). The effect of the ABC pathway was consistent in clinical trials versus real-world studies, but influenced by study-level characteristics, including geographical location, mean age, prevalence of comorbidities, and the inclusion of estimates adjusted for potential confounders. Adherence to the ABC pathway remains suboptimal in patients with AF, but is associated with substantial beneficial effects on prognosis. Our data support widespread implementation of the ABC pathway for managing patients with AF.