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.

Romiti, Giulio Francesco;Proietti, Marco;Vitolo, Marco;Bonini, Niccolò;Blommaert, Dominique;et.al.
(2022) BMC Medicine — Vol. 20, n° 1, p. 326 (2022)

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Authors
  • Romiti, Giulio Francesco
    Author
  • Proietti, Marco
    Author
  • Vitolo, Marco
    Author
  • Bonini, Niccolò
    Author
  • Deceuninck, OlivierUCLouvain
    Collaborator
  • Xhaet, OlivierUCLouvain
    Collaborator
  • DORMAL, Fabienorcid-logoUCLouvain
    Collaborator
  • BALLANT, ElisabethUCLouvain
    Collaborator
  • Blommaert, DominiqueUCLouvain
    Collaborator
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Abstract
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. 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. 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. 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.
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Romiti, G. F., Proietti, M., Vitolo, M., Bonini, N., Fawzy, A. M., Ding, W. Y., Fauchier, L., Marin, F., Nabauer, M., Dan, G. A., Potpara, T. S., Boriani, G., & Lip, G. Y. H. (2022). 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. BMC Medicine, 20(1), 326. https://doi.org/10.1186/s12916-022-02526-7 (Original work published 2022)