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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References
- Cause of death and predictors of all-cause mortality in anticoagulated patients with nonvalvular atrial fibrillation: data from ROCKET AF.J Am Heart Assoc. 2016; 5e002197
- Atrial fibrillation and incident myocardial infarction in the elderly.Clin Cardiol. 2014; 37: 750-755
- Acute myocardial infarction in patients with atrial fibrillation with a CHA2DS2-VASc score of 0 or 1: a nationwide cohort study.Heart Rhythm. 2014; 11: 1941-1947
- Should atrial fibrillation patients with only 1 nongender-related CHA2DS2-VASc risk factor be anticoagulated?.Stroke. 2016; 47: 1831-1836
- Atrial fibrillation and the risk of myocardial infarction.JAMA Intern. Med. 2014; 174: 107-114
- Inadequate anticoagulation by VITAMIN K antagonists is associated with major adverse cardiovascular Events in patients with atrial fibrillation.Int J Cardiol. 2015; 201: 513-516
- Group A-As. Long-term risk of major adverse cardiac events in atrial fibrillation patients on direct oral anticoagulants.Mayo Clin Proc. 2020; S0025-619630854-5https://doi.org/10.1016/j.mayocp.2020.06.057
- Causes of death and influencing factors in patients with atrial fibrillation.Am J Med. 2016; 129: 1278-1287
- Predicting adverse events beyond stroke and bleeding with the ABC-stroke and ABC-bleeding scores in patients with atrial fibrillation: the murcia AF project.Thromb Haemost. 2020; 120: 1200-1207https://doi.org/10.1055/s-0040-1712914
- The ABC pathway: an integrated approach to improve AF management.Nat Rev Cardiol. 2017; 14: 627-628
- Improved outcomes by integrated care of anticoagulated patients with atrial fibrillation using the simple ABC (Atrial fibrillation Better Care) pathway.Am J Med. 2018; 11: 1359-1366https://doi.org/10.1016/j.amjmed.2018.06.012
- Integrated care management of patients with atrial fibrillation and risk of cardiovascular events: the ABC (Atrial fibrillation Better Care) pathway in the ATHERO-AF study cohort.Mayo Clin Proc. 2019; 94: 1261-1267
- Antithrombotic therapy for atrial fibrillation: CHEST guideline and expert panel report.Chest. 2018; 154: 1121-1201
- Female sex as a risk modifier for stroke risk in atrial fibrillation: using CHA2DS2-VASc versus CHA2DS2-VA for stroke risk stratification in atrial fibrillation: a note of caution.Thromb Haemost. 2020; 120: 894-898
- Adverse cardiovascular outcomes in atrial fibrillation: validation of the new 2MACE risk score.Int J Cardiol. 2017; 249: 191-197
- Usefulness of the 2MACE score to predicts adverse cardiovascular events in patients with atrial fibrillation.Am J Cardiol. 2017; 120: 2176-2181
- ABC (Atrial fibrillation Better Care) pathway and healthcare costs in atrial fibrillation: the ATHERO-AF study.Am J Med. 2019; 132: 856-861
- Cardiovascular risk stratification in patients with non-valvular atrial fibrillation: the 2MACE score.Intern Emerg Med. 2016; 11: 199-204
- Incidence of myocardial infarction and vascular death in elderly patients with atrial fibrillation taking anticoagulants: relation to atherosclerotic risk factors.Chest. 2015; 147: 1644-1650
- Adherence to the ABC (Atrial fibrillation Better Care) pathway in the Balkan region: the BALKAN-AF survey.Pol Arch Intern Med. 2020; 130: 187-195
- Compliance of atrial fibrillation treatment with the Atrial fibrillation Better Care (ABC) pathway improves the clinical outcomes in the middle east population: a report from the gulf survey of atrial fibrillation events (SAFE) registry.J Clin Med. 2020; 9
- Improved population-based clinical outcomes of patients with atrial fibrillation by compliance with the simple ABC (Atrial fibrillation Better Care) pathway for integrated care management: a nationwide cohort study.Thromb Haemost. 2019; 119: 1695-1703
- Sex-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro observational research programme pilot survey on atrial fibrillation.Europace. 2015; 17: 24-31
- 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS).Eur Heart J. 2020; ehaa612https://doi.org/10.1093/eurheartj/ehaa612
- Ischaemic cardiac outcomes in patients with atrial fibrillation treated with vitamin K antagonism or factor Xa inhibition: results from the ROCKET AF trial.Eur Heart J. 2014; 35: 233-241
- Sex and racial differences in cardiovascular disease risk in patients with atrial fibrillation.PLoS One. 2019; 14e0222147
- Sex/gender differences in cardiovascular disease prevention: what a difference a decade makes.Circulation. 2011; 124: 2145-2154
Article info
Publication history
Published online: December 21, 2020
Accepted:
December 12,
2020
Received:
December 9,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
