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Impact of ABC (Atrial Fibrillation Better Care) pathway adherence in high-risk subgroups with atrial fibrillation: A report from the ESC-EHRA EORP-AF long-term general registry

  • Author Footnotes
    1 joint first authors
    Wern Yew Ding
    Footnotes
    1 joint first authors
    Affiliations
    Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
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  • Author Footnotes
    1 joint first authors
    Marco Proietti
    Footnotes
    1 joint first authors
    Affiliations
    Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom

    Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy

    Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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  • Giulio Francesco Romiti
    Affiliations
    Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom

    Department of Translational and Precision Medicine, Sapienza – University of Rome, Italy
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  • Marco Vitolo
    Affiliations
    Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom

    Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy

    Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
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  • Ameenathul Mazaya Fawzy
    Affiliations
    Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
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  • Giuseppe Boriani
    Affiliations
    Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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  • Francisco Marin
    Affiliations
    Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBERCV, Murcia, Spain
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  • Carina Blomström-Lundqvist
    Affiliations
    School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

    Department of Medical Science, Uppsala University, Uppsala, Sweden
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  • Tatjana S. Potpara
    Affiliations
    School of Medicine, University of Belgrade, Belgrade, Serbia

    Intensive Arrhythmia Care, Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
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  • Laurent Fauchier
    Affiliations
    Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
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  • Gregory Y. H Lip
    Correspondence
    Corresponding author.
    Affiliations
    Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom

    Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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  • on behalf of the
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    1 joint first authors
Published:November 10, 2022DOI:https://doi.org/10.1016/j.ejim.2022.11.004

      Highlights

      • Patients with atrial fibrillation often suffer from other comorbidities such as chronic kidney disease, advanced age or prior thromboembolism.
      • These patients were treated infrequently with a holistic care approached as assessed by adherence to the ABC pathway.
      • ABC pathway adherence was associated with a significant reduction in the composite risk of all-cause death, thromboembolism and acute coronary syndrome.
      • Patients who fulfilled an increasing number of ABC criteria had a progressive improvement in long-term prognosis.

      Abstract

      Background

      Effects of Atrial Fibrillation Better Care (ABC) adherence among high-risk atrial fibrillation (AF) subgroups remains unknown. We aimed to evaluate the impact of ABC adherence on clinical outcomes in these high-risk patients.

      Methods

      EORP-AF General Long-Term Registry is a prospective, observational registry from 250 centres across 27 European countries. High-risk patients were defined as those with either CKD (eGFR <60 mL/min/1.73m2), elderly patients (≥75 years) or prior thromboembolism. Primary outcome was a composite event of all-cause death, thromboembolism and acute coronary syndrome.

      Results

      6646 patients with AF were screened (median age was 70 [IQR 61 – 77] years; 40.2% females). There were 3304 (54.2%) patients with either CKD (n = 1750), older age (n = 2236) or prior thromboembolism (n = 728). Among these, 924 (28.0%) were managed as adherent to ABC. At 2-year follow-up, 966 (14.5%) patients reported the primary outcome. The incidence of the primary outcome was significantly lower in high-risk patients managed as adherent to ABC pathway (IRR 0.53 [95%CI, 0.43 – 0.64]). Consistent results were obtained in the individual subgroups. Using multivariable Cox proportional hazards analysis, ABC adherence in the high-risk cohort was independently associated with a lower risk of the primary outcome (aHR 0.64 [95%CI, 0.51 – 0.80]), as well as in the CKD (aHR 0.51 [95%CI, 0.37 – 0.70]) and elderly subgroups (aHR 0.69 [95%CI, 0.53 – 0.90]). Overall, there was greater reduction in the risk of primary outcome as more ABC criteria were fulfilled, both in the overall high-risk patients (aHR 0.39 [95%CI, 0.25 – 0.61]), as well as in the individual subgroups.

      Conclusion

      In a large, contemporary cohort of patients with AF, we demonstrate that adherence to the ABC pathway was associated with a significant benefit among high-risk patients with either CKD, advanced age (≥75 years old) or prior thromboembolism.

      Keywords

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