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
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 usef...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-09-01
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| Series: | BMC Medicine |
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| Online Access: | https://doi.org/10.1186/s12916-022-02526-7 |
| _version_ | 1817994066955075584 |
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| author | Giulio Francesco Romiti Marco Proietti Marco Vitolo Niccolò Bonini Ameenathul Mazaya Fawzy Wern Yew Ding Laurent Fauchier Francisco Marin Michael Nabauer Gheorghe Andrei Dan Tatjana S. Potpara Giuseppe Boriani Gregory Y. H. Lip on behalf of the ESC-EHRA EORP-AF General Long-Term Registry Investigators |
| author_facet | Giulio Francesco Romiti Marco Proietti Marco Vitolo Niccolò Bonini Ameenathul Mazaya Fawzy Wern Yew Ding Laurent Fauchier Francisco Marin Michael Nabauer Gheorghe Andrei Dan Tatjana S. Potpara Giuseppe Boriani Gregory Y. H. Lip on behalf of the ESC-EHRA EORP-AF General Long-Term Registry Investigators |
| author_sort | Giulio Francesco Romiti |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-14T01:47:10Z |
| format | Article |
| id | doaj.art-a8f47e6d20f141bcb20d1cde473a30a1 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-04-14T01:47:10Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-a8f47e6d20f141bcb20d1cde473a30a12022-12-22T02:19:29ZengBMCBMC Medicine1741-70152022-09-0120111210.1186/s12916-022-02526-7Clinical 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 RegistryGiulio Francesco Romiti0Marco Proietti1Marco Vitolo2Niccolò Bonini3Ameenathul Mazaya Fawzy4Wern Yew Ding5Laurent Fauchier6Francisco Marin7Michael Nabauer8Gheorghe Andrei Dan9Tatjana S. Potpara10Giuseppe Boriani11Gregory Y. H. Lip12on behalf of the ESC-EHRA EORP-AF General Long-Term Registry InvestigatorsLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest HospitalLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest HospitalLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest HospitalLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest HospitalLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest HospitalLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest HospitalService de Cardiologie, Centre Hospitalier Universitaire TrousseauDepartment of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CVDepartment of Cardiology, Ludwig-Maximilians-UniversityUniversity of Medicine, ‘Carol Davila’, Colentina University HospitalSchool of Medicine, University of BelgradeCardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di ModenaLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest HospitalAbstract 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.https://doi.org/10.1186/s12916-022-02526-7Atrial fibrillationIntegrated managementOutcomesClinical complexity |
| spellingShingle | Giulio Francesco Romiti Marco Proietti Marco Vitolo Niccolò Bonini Ameenathul Mazaya Fawzy Wern Yew Ding Laurent Fauchier Francisco Marin Michael Nabauer Gheorghe Andrei Dan Tatjana S. Potpara Giuseppe Boriani Gregory Y. H. Lip on behalf of the ESC-EHRA EORP-AF General Long-Term Registry Investigators 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 Atrial fibrillation Integrated management Outcomes Clinical complexity |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Atrial fibrillation Integrated management Outcomes Clinical complexity |
| url | https://doi.org/10.1186/s12916-022-02526-7 |
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