Integrated Care for Atrial Fibrillation Using the ABC Pathway in the Prospective APHRS-AF Registry

Abstract

<h3>Background</h3><p>The Atrial Fibrillation Better Care (ABC) has been proposed as an integrated approach to improve management <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/inpatient" title="Learn more about in patients from ScienceDirect's AI-generated Topic Pages">in patients</a> with atrial fibrillation (AF), based on 3 pillars: “A” Avoid stroke with <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/anticoagulation" title="Learn more about Anticoagulation from ScienceDirect's AI-generated Topic Pages">Anticoagulation</a>; “B” Better symptoms control; “C” Cardiovascular risk-factor and comorbidities management.</p><h3>Objectives</h3><p>This study sought to investigate the association with outcomes of ABC adherence in the prospective multinational Asia-Pacific Heart Rhythm Society (APHRS) Atrial Fibrillation registry.</p><h3>Method</h3><p>Cox-regression analyses adjusted for age, sex, CHA₂DS₂-VASc score, <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/paroxysmal-atrial-fibrillation" title="Learn more about paroxysmal AF from ScienceDirect's AI-generated Topic Pages">paroxysmal AF</a>, <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/chronic-obstructive-pulmonary-disease" title="Learn more about chronic obstructive pulmonary disease from ScienceDirect's AI-generated Topic Pages">chronic obstructive pulmonary disease</a>, <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/chronic-kidney-disease" title="Learn more about chronic kidney disease from ScienceDirect's AI-generated Topic Pages">chronic kidney disease</a>, cancer, <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/dyslipidemia" title="Learn more about dyslipidemia from ScienceDirect's AI-generated Topic Pages">dyslipidemia</a>, and dementia were performed to investigate the association with outcomes. Primary outcome was a composite of all-cause death, any <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/thromboembolism" title="Learn more about thromboembolic from ScienceDirect's AI-generated Topic Pages">thromboembolic</a> events, <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/acute-coronary-syndrome" title="Learn more about acute coronary syndrome from ScienceDirect's AI-generated Topic Pages">acute coronary syndrome</a> or percutaneous interventional procedures, and advancing heart failure.</p><h3>Results</h3><p>Of the 4,013 included patients with AF (mean age 68 ± 12 years; 34.4% female); 38.6% were adherent to all 3 main ABC pillars. After 1 year of follow-up, adherence to the <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/care-pathway" title="Learn more about ABC pathway from ScienceDirect's AI-generated Topic Pages">ABC pathway</a> was associated with a low incidence of composite outcome (4.0% vs 8.5%, <em>P</em> < 0.001), all-cause and cardiovascular death, and advancing heart failure. On <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/proportional-hazards-model" title="Learn more about Cox regression from ScienceDirect's AI-generated Topic Pages">Cox regression</a> analysis, ABC adherence was associated with a lower risk of primary outcome (HR: 0.72; 95% CI: 0.53-0.97), with risk reduction progressively higher with a higher number of ABC criteria attained. No significant interaction in the association was seen according to the different geographic areas (<em>P</em>_int = 0.217).</p><h3>Conclusions</h3><p>In a large contemporary cohort of Asian patients with AF, adherence to ABC pathway was associated with a reduction of the risk for <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/adverse-outcome" title="Learn more about adverse outcomes from ScienceDirect's AI-generated Topic Pages">adverse outcomes</a>.</p>