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The Atrial fibrillation Better Care (ABC) pathway and cardiac complications in atrial fibrillation: a potential sex-based difference. The ATHERO-AF study

  • Daniele Pastori
    Correspondence
    Corresponding author at: Atherothrombosis Center, I Clinica Medica, Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences. Sapienza University of Rome. Viale del Policlinico 155, Roma, 00161, Italy.
    Affiliations
    Department of Clinical Internal, Anesthesiologic, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy

    Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, United Kingdom
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  • Danilo Menichelli
    Affiliations
    Department of Clinical Internal, Anesthesiologic, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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  • Francesco Violi
    Affiliations
    Department of Clinical Internal, Anesthesiologic, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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  • Author Footnotes
    1 Joint senior authors.
    Pasquale Pignatelli
    Footnotes
    1 Joint senior authors.
    Affiliations
    Department of Clinical Internal, Anesthesiologic, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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  • Author Footnotes
    1 Joint senior authors.
    Gregory Y H Lip
    Footnotes
    1 Joint senior authors.
    Affiliations
    Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, United Kingdom

    Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
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  • the ATHERO-AF study group
    Author Footnotes
    2 ATHERO-AF study members: Marco Antonio Casciaro, Mirella Saliola, Francesco Del Sole, Francesco Aleo.
  • Author Footnotes
    1 Joint senior authors.
    2 ATHERO-AF study members: Marco Antonio Casciaro, Mirella Saliola, Francesco Del Sole, Francesco Aleo.
Published:December 21, 2020DOI:https://doi.org/10.1016/j.ejim.2020.12.011

      Abstract

      Background

      An integrated care approach is recommended to optimize management of patients with atrial fibrillation (AF). The impact of the Atrial fibrillation Better Care (ABC) pathway on major adverse cardiac events (MACE), which are the main causes of death in AF, has not been explored.

      Material and methods

      We investigated the association between ABC compliance and MACE incidence in 1157 (2690 patient-years) nonvalvular AF patients from the ATHERO-AF study. A subgroup analysis by sex and high cardiovascular risk patients as defined by a 2MACE score ≥3 was performed.

      Results

      Overall, 428 (37%) patients composed the ABC-compliant group. During a median follow up of 23 (IQR 12-37) months, 64 MACE occurred (2.38%/year). Kaplan Meier curve analysis showed a higher rate of MACE in ABC non-compliant group compared to the ABC-compliant (log-rank test p=0.006). The risk of MACE increased by the number of non-fulfilled ABC criteria. On multivariable Cox proportional hazard regression analysis, the ABC non-compliance was associated with an increased risk of MACE (Hazard ratio (HR) 2.244, 95% Confidence Interval (95%CI) 1.129-4.462). Men were more likely to have suboptimal anticoagulation control (group A), while uncontrolled symptoms were more frequent in women. The association between non-ABC and MACE was more evident in men than women (HR 3.647, 95%CI 1.294-10.277) and in patients with 2MACE score ≥3 (HR 1.728, 95%CI 1.209-2.472).

      Conclusion

      An integrated care ABC approach is associated with a reduced risk of MACE in the AF population, especially in men and in patients at high risk of MACE.

      Keywords

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