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, Marco Proietti, Marco Vitolo, Niccolò Bonini, Ameenathul M. Fawzy, Wern Yew Ding, Laurent Fauchier, Francisco Marı́n, Michael Näbauer, Gheorghe Andrei Dan, Tatjana Potpara, Giuseppe Boriani, Gregory Y.H. Lip, on behalf of the ESC-EHRA EORP-AF General Long-Term Registry Investigators, Luigi Tavazzi, Aldo P. Maggioni, Zbigniew Kalarus, R. Ferrari, Alena Shantsila, Artan Goda, Georges H. Mairesse, T. Shalganov, Loizos Antoniades, Miloš Táborský, Sam Riahi, Piibe Muda, Ignacio García Bolao, Olivier Piot, Kakhaber Etsadashvili, Εmmanuel Simantirakis, Moti Haim, Amirhossein Azhari, Jamshid Najafian, Massimo Santini, Erkin М Мirrakhimov, K a Kulzida, A. Erglis, Lidija Poposka, M Burg, H. Crijns, Ömer Erküner, D. Atar, Radosław Lenarczyk, Mário Oliveira, D. Shah, E Serdechnaya, E. Diker, Deirdre A. Lane, E Zëra, U Ekmekçiu, Vilma Paparisto, Mihal Tase, H Gjergo, J Dragoti, Artan Goda, M Ciutea, N. Ahadi, Ziad El Husseini, M. Raepers, J. Leroy, P Haushan, A Jourdan, Caroline Lepièce, Lien Desteghe, Johan Vijgen, Pieter Koopman, G. Van Genechten, Hein Heidbüchel, Tim Boussy, M De Coninck, Hannelore Van Eeckhoutte, N Bouckaert, Alain Friart, J. Boreux, C Arend, P Evrard, L Stefan, E Hoffer, J. Herzet, M Massoz, C. Celentano, Muriel Sprynger, Luc Piérard, P Mélon, B Van Hauwaert, C. Kuppens, Dirk Faes, Dirk van Lier, A. Van Dorpe, A. Gerardy, Olivier Deceuninck, Olivier Xhaët, Fabien Dormal, Elisabeth Ballant, Dominique Blommaert, D. Yakova, Mihail Hristov, T Yncheva, N. Stancheva, S. Tisheva
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.