Advertisement

Adherence to the “Atrial fibrillation Better Care” (ABC) pathway in patients with atrial fibrillation and cancer: A report from the ESC-EHRA EURObservational Research Programme in atrial fibrillation (EORP-AF) General Long-Term Registry

Published:August 23, 2022DOI:https://doi.org/10.1016/j.ejim.2022.08.004

      Highlights

      • Appropriate management of AF patients with cancer in real-world clinical practice is challenging.
      • In this EORP-AF study, we analyzed a cohort of AF patients with prior or active cancer.
      • A structured approach based on the “Atrial fibrillation Better Care” (ABC) Pathway is still suboptimal.
      • Adherence to the “C” criterion (i.e. management of comorbidities) was more critical, being specifically lower in cancer patients.
      • Adherence to the ABC pathway was independently associated with a lower risk outcomes.

      Abstract

      Background

      Implementation of the Atrial fibrillation Better Care (ABC) pathway is recommended by guidelines on atrial fibrillation (AF), but the impact of adherence to ABC pathway in patients with cancer is unknown.

      Objectives

      To investigate the adherence to ABC pathway and its impact on adverse outcomes in AF patients with cancer.

      Methods

      Patients enrolled in the EORP-AF General Long-Term Registry were analyzed according to (i) No Cancer; and (ii) Prior or active cancer and stratified in relation to adherence to the ABC pathway. The composite Net Clinical Outcome (NCO) of all-cause death, major adverse cardiovascular events and major bleeding was the primary endpoint.

      Results

      Among 6550 patients (median age 69 years, females 40.1%), 6005 (91.7%) had no cancer, while 545 (8.3%) had a diagnosis of active or prior cancer at baseline, with the proportions of full adherence to ABC pathway of 30.6% and 25.7%, respectively. Adherence to the ABC pathway was associated with a significantly lower occurrence of the primary outcome vs. non-adherence, both in ‘no cancer’ and ‘cancer’ patients [adjusted Hazard Ratio (aHR) 0.78, 95% confidence interval (CI): 0.66–0.92 and aHR 0.59, 95% CI 0.37–0.96, respectively]. Adherence to a higher number of ABC criteria was associated with a lower risk of the primary outcome, being lowest when 3 ABC criteria were fulfilled (no cancer: aHR 0.54, 95%CI: 0.36–0.81; with cancer: aHR 0.32, 95% CI 0.13–0.78).

      Conclusion

      In AF patients with cancer enrolled in the EORP-AF General Long-Term Registry, adherence to ABC pathway was sub-optimal. Full adherence to ABC-pathway was associated with a lower risk of adverse events

      Graphic abstract

      Keywords

      Abbreviation:

      ABC (Atrial Fibrillation Better Care), ACS (acute coronary syndrome), AF (atrial fibrillation), CAD (coronary artery disease), CKD (chronic kidney disease), CI (confidence interval), CV (cardiovascular), EHRA (European Heart Rhythm Association), EORP (EURObservational Research Programme), ESC (European Society of Cardiology), HF (heart failure), HR (hazard ratio), IQR (interquartile range), MACE (major adverse cardiovascular events), MI (myocardial infarction), NCO (net clinical outcome), SE (systemic embolisms), TE (thromboembolic events)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lip G.Y.H.
        The ABC pathway: an integrated approach to improve AF management.
        Nat Rev Cardiol. 2017; 14: 627-628
        • Stevens D.
        • Harrison S.L.
        • Kolamunnage-Dona R.
        • Lip G.Y.H.
        • Lane D.A.
        The Atrial fibrillation Better Care pathway for managing atrial fibrillation: a review.
        EP Eur. 2021; 23: 1511-1527
        • Chao T.F.
        • Joung B.
        • Takahashi Y.
        • et al.
        2021 focused update consensus guidelines of the Asia pacific heart rhythm society on stroke prevention in atrial fibrillation: executive summary.
        Thromb Haemost. 2022; 122: 20-47
        • Proietti M.
        • Lip G.Y.H.
        • Laroche C.
        • et al.
        Relation of outcomes to ABC (Atrial fibrillation Better Care) pathway adherent care in European patients with atrial fibrillation: an analysis from the ESC-EHRA EORP atrial fibrillation general long-term (AFGen LT) registry.
        Europace. 2021; 23: 174-183
        • Proietti M.
        • Romiti G.F.
        • Olshansky B.
        • Lane D.A.
        • Lip GYH.
        Comprehensive management with the ABC (Atrial fibrillation Better Care) pathway in clinically complex patients with atrial fibrillation: a post hoc ancillary analysis from the AFFIRM trial.
        J Am Heart Assoc. 2020; 9e014932
        • Guo Y.
        • Imberti J.
        • Kotalczyk A.
        • et al.
        Atrial fibrillation better care pathway adherent care improves outcomes in chinese patients with atrial fibrillation.
        JACC: Asia. 2022; https://doi.org/10.1016/j.jacasi.2022.01.007
        • Boriani G.
        • Vitolo M.
        • Lane D.A.
        • Potpara T.S.
        • Lip GY.
        Beyond the 2020 guidelines on atrial fibrillation of the European society of cardiology.
        Eur J Intern Med. 2021; 86: 1-11
        • Yang P.S.
        • Sung J.H.
        • Jang E.
        • et al.
        Application of the simple Atrial fibrillation Better Care pathway for integrated care management in frail patients with atrial fibrillation: a nationwide cohort study.
        J Arrhythm. 2020; 36: 668-677
        • Yang P.S.
        • Sung J.H.
        • Jang E.
        • et al.
        The effect of integrated care management on dementia in atrial fibrillation.
        J Clin Med. 2020; 9: 1696
        • Guo Y.
        • Imberti J.F.
        • Kotalczyk A.
        • Wang Y.
        • Lip GYH.
        4S-AF scheme and ABC pathway guided management improves outcomes in atrial fibrillation patients.
        Eur J Clin Invest. 2022; : e13751
        • Malavasi V.L.
        • Vitolo M.
        • Proietti M.
        • et al.
        Impact of malignancy on outcomes in European patients with atrial fibrillation: a report from the ESC-EHRA EURObservational research programme in atrial fibrillation General Long-Term Registry.
        Eur J Clin Invest. 2022; : e13773
        • Chan Y.H.
        • Chao T.F.
        • Lee H.F.
        • et al.
        Clinical outcomes in atrial fibrillation patients with a history of cancer treated with non-vitamin K antagonist oral anticoagulants: a nationwide cohort study.
        Stroke. 2021; 52: 3132-3141
        • Boriani G.
        • Proietti M.
        • Laroche C.
        • et al.
        Association between antithrombotic treatment and outcomes at 1-year follow-up in patients with atrial fibrillation: the EORP-AF General Long-Term Registry.
        Europace. 2019; 21: 1013-1022
        • Vitolo M.
        • Proietti M.
        • Harrison S.
        • et al.
        The euro heart survey and EURObservational research programme (EORP) in atrial fibrillation registries: contribution to epidemiology, clinical management and therapy of atrial fibrillation patients over the last 20 years.
        Intern Emerg Med. 2020; 15: 1183-1192
        • Frere C.
        • Crichi B.
        • Lejeune M.
        • Spano J.P.
        • Janus N.
        Are patients with active cancer and those with history of cancer carrying the same risks of recurrent vte and bleeding while on anticoagulants?.
        Cancers. 2020; 12 (Basel) 917: 917
        • Khorana A.A.
        • Noble S.
        • Lee A.Y.Y.
        • et al.
        Role of direct oral anticoagulants in the treatment of cancer-associated venous thromboembolism: guidance from the SSC of the ISTH.
        J Thromb Haemost. 2018; 16: 1891-1894
        • Mosarla R.C.
        • Vaduganathan M.
        • Qamar A.
        • Moslehi J.
        • Piazza G.
        • Giugliano RP.
        Anticoagulation strategies in patients with cancer: JACC review topic of the week.
        J Am Coll Cardiol. 2019; 73: 1336-1349
        • Farmakis D.
        Anticoagulation for atrial fibrillation in active cancer: what the cardiologists think.
        Eur J Prev Cardiol. 2020; 28: 608-610
        • Boriani G.
        • Lee G.
        • Parrini I.
        • et al.
        Anticoagulation in patients with atrial fibrillation and active cancer: an international survey on patient management.
        Eur J Prev Cardiol. 2021; 28: 611-621
        • Malavasi V.L.
        • Fantecchi E.
        • Gianolio L.
        • et al.
        Atrial fibrillation in patients with active malignancy and use of anticoagulants: under-prescription but no adverse impact on all-cause mortality.
        Eur J Intern Med. 2019; 59: 27-33
        • Atterman A.
        • Friberg L.
        • Asplund K.
        • Engdahl J.
        Atrial fibrillation, oral anticoagulants, and concomitant active cancer: benefits and risks.
        TH Open. 2021; 5: e176-e182
        • Cavallari I.
        • Verolino G.
        • Romano S.
        • Patti G.
        Efficacy and safety of nonvitamin K oral anticoagulants in patients with atrial fibrillation and cancer: a study-level meta-analysis.
        Thromb Haemost. 2020; 120: 314-321
        • Toma M.
        • Rrapaj E.
        • Spallarossa P.
        • Guerra F.
        • Ameri P.
        Patterns of anticoagulation for atrial fibrillation in cancer patients referred to cardio-oncological evaluation.
        Eur J Intern Med. 2020; 82: 128-129
        • López-Fernández T.
        • Martín-García A.
        • Roldán Rabadán I.
        • et al.
        Atrial fibrillation in active cancer patients: expert position paper and recommendations.
        Rev Esp Cardiol. 2019; 72 (Engl Ed): 749-759
        • Yun J.P.
        • Choi E.K.
        • Han K.D.
        • et al.
        Risk of atrial fibrillation according to cancer type.
        JACC: CardioOncol. 2021; 3: 221-232
        • Weaver K.E.
        • Foraker R.E.
        • Alfano C.M.
        • et al.
        Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care?.
        J Cancer Surviv. 2013; 7: 253-261
        • Guo Y.
        • Lane D.A.
        • Wang L.
        • et al.
        Mobile health technology to improve care for patients with atrial fibrillation.
        J Am Coll Cardiol. 2020; 75: 1523-1534
        • Guo Y.
        • Guo J.
        • Shi X.
        • et al.
        Mobile health technology-supported atrial fibrillation screening and integrated care: a report from the mAFA-II trial long-term extension cohort.
        Eur J Intern Med. 2020; 82: 105-111
        • Yoon M.
        • Yang P.S.
        • Jang E.
        • et al.
        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; 19: 1695-1703
        • Romiti G.F.
        • Pastori D.
        • Rivera-Caravaca J.M.
        • et al.
        Adherence to the ‘Atrial fibrillation Better Care’ pathway in patients with atrial fibrillation: impact on clinical outcomes-a systematic review and meta-analysis of 285,000 patients.
        Thromb Haemost. 2021; 122: 406-414
        • Yao Y.
        • Guo Y.
        • Lip G.Y.H.
        The effects of implementing a mobile health-technology supported pathway on atrial fibrillation-related adverse events among patients with multimorbidity: the mAFA-II randomized clinical trial.
        JAMA Netw Open. 2021; 4e2140071
        • Proietti M.
        • Vitolo M.
        • Lip GYH.
        Integrated care and outcomes in patients with atrial fibrillation and comorbidities.
        Eur J Clin Invest. 2021; : e13498
        • Lestuzzi C.
        • Annunziata M.A.
        • Nohria A.
        • Muzzatti B.
        • Bisceglia I.
        • Ewer M.S.
        Cancer patients in cardiology: how to communicate with patients with special psychological needs and manage their cardiac problems in daily clinical practice.
        J Cardiovasc Med (Hagerstown). 2020; 21: 286-291