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The Effect of Integrated Care Management on Dementia in Atrial Fibrillation

Clinical outcomes of patients with atrial fibrillation (AF) can be improved by an integrated care approach. We analyzed whether adherence with the AF Better Care (ABC) pathway for integrated care management would reduce the risk of dementia in a nationwide AF cohort. Using the National Health Insura...

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Autores principales: Yang, Pil-Sung, Sung, Jung-Hoon, Jang, Eunsun, Yu, Hee Tae, Kim, Tae-Hoon, Uhm, Jae-Sun, Kim, Jong-Youn, Pak, Hui-Nam, Lee, Moon-Hyoung, Lip, Gregory Y. H., Joung, Boyoung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356978/
https://www.ncbi.nlm.nih.gov/pubmed/32498299
http://dx.doi.org/10.3390/jcm9061696
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author Yang, Pil-Sung
Sung, Jung-Hoon
Jang, Eunsun
Yu, Hee Tae
Kim, Tae-Hoon
Uhm, Jae-Sun
Kim, Jong-Youn
Pak, Hui-Nam
Lee, Moon-Hyoung
Lip, Gregory Y. H.
Joung, Boyoung
author_facet Yang, Pil-Sung
Sung, Jung-Hoon
Jang, Eunsun
Yu, Hee Tae
Kim, Tae-Hoon
Uhm, Jae-Sun
Kim, Jong-Youn
Pak, Hui-Nam
Lee, Moon-Hyoung
Lip, Gregory Y. H.
Joung, Boyoung
author_sort Yang, Pil-Sung
collection PubMed
description Clinical outcomes of patients with atrial fibrillation (AF) can be improved by an integrated care approach. We analyzed whether adherence with the AF Better Care (ABC) pathway for integrated care management would reduce the risk of dementia in a nationwide AF cohort. Using the National Health Insurance Service database of Korea, 228,026 non-valvular AF patients were retrospectively evaluated between 2005 and 2015. Patients meeting all criteria of the ABC pathway were classified as the “ABC” group and those not classified as the “non-ABC” group. During a median (25th, 75th percentiles) follow-up of 6.0 (3.3, 9.5) years, the ABC group had lower rates and risk of overall dementia (0.17 vs. 1.11 per 100 person-years, p < 0.001; hazard ratio (HR) 0.80; 95% CI 0.73–0.87) and both Alzheimer’s (HR 0.79, 95% CI 0.71–0.88) and vascular dementia (HR 0.76, 95% CI 0.59–0.98) than the non-ABC group. The stratified analysis showed that the ABC pathway reduced the risk of dementia regardless of sex, comorbidities, and in patients with high stroke risk. Adherence with the ABC pathway is associated with a reduced risk of dementia in AF patients. Due to the high medical burden of AF, it is necessary to implement integrated AF management to reduce the risk of dementia.
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spelling pubmed-73569782020-07-23 The Effect of Integrated Care Management on Dementia in Atrial Fibrillation Yang, Pil-Sung Sung, Jung-Hoon Jang, Eunsun Yu, Hee Tae Kim, Tae-Hoon Uhm, Jae-Sun Kim, Jong-Youn Pak, Hui-Nam Lee, Moon-Hyoung Lip, Gregory Y. H. Joung, Boyoung J Clin Med Article Clinical outcomes of patients with atrial fibrillation (AF) can be improved by an integrated care approach. We analyzed whether adherence with the AF Better Care (ABC) pathway for integrated care management would reduce the risk of dementia in a nationwide AF cohort. Using the National Health Insurance Service database of Korea, 228,026 non-valvular AF patients were retrospectively evaluated between 2005 and 2015. Patients meeting all criteria of the ABC pathway were classified as the “ABC” group and those not classified as the “non-ABC” group. During a median (25th, 75th percentiles) follow-up of 6.0 (3.3, 9.5) years, the ABC group had lower rates and risk of overall dementia (0.17 vs. 1.11 per 100 person-years, p < 0.001; hazard ratio (HR) 0.80; 95% CI 0.73–0.87) and both Alzheimer’s (HR 0.79, 95% CI 0.71–0.88) and vascular dementia (HR 0.76, 95% CI 0.59–0.98) than the non-ABC group. The stratified analysis showed that the ABC pathway reduced the risk of dementia regardless of sex, comorbidities, and in patients with high stroke risk. Adherence with the ABC pathway is associated with a reduced risk of dementia in AF patients. Due to the high medical burden of AF, it is necessary to implement integrated AF management to reduce the risk of dementia. MDPI 2020-06-02 /pmc/articles/PMC7356978/ /pubmed/32498299 http://dx.doi.org/10.3390/jcm9061696 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Yang, Pil-Sung
Sung, Jung-Hoon
Jang, Eunsun
Yu, Hee Tae
Kim, Tae-Hoon
Uhm, Jae-Sun
Kim, Jong-Youn
Pak, Hui-Nam
Lee, Moon-Hyoung
Lip, Gregory Y. H.
Joung, Boyoung
The Effect of Integrated Care Management on Dementia in Atrial Fibrillation
title The Effect of Integrated Care Management on Dementia in Atrial Fibrillation
title_full The Effect of Integrated Care Management on Dementia in Atrial Fibrillation
title_fullStr The Effect of Integrated Care Management on Dementia in Atrial Fibrillation
title_full_unstemmed The Effect of Integrated Care Management on Dementia in Atrial Fibrillation
title_short The Effect of Integrated Care Management on Dementia in Atrial Fibrillation
title_sort effect of integrated care management on dementia in atrial fibrillation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356978/
https://www.ncbi.nlm.nih.gov/pubmed/32498299
http://dx.doi.org/10.3390/jcm9061696
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