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Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

BACKGROUND: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness a...

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Autores principales: Romiti, Giulio Francesco, Proietti, Marco, Vitolo, Marco, Bonini, Niccolò, Fawzy, Ameenathul Mazaya, Ding, Wern Yew, Fauchier, Laurent, Marin, Francisco, Nabauer, Michael, Dan, Gheorghe Andrei, Potpara, Tatjana S., Boriani, Giuseppe, Lip, Gregory Y. H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9440492/
https://www.ncbi.nlm.nih.gov/pubmed/36056426
http://dx.doi.org/10.1186/s12916-022-02526-7
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author Romiti, Giulio Francesco
Proietti, Marco
Vitolo, Marco
Bonini, Niccolò
Fawzy, Ameenathul Mazaya
Ding, Wern Yew
Fauchier, Laurent
Marin, Francisco
Nabauer, Michael
Dan, Gheorghe Andrei
Potpara, Tatjana S.
Boriani, Giuseppe
Lip, Gregory Y. H.
author_facet Romiti, Giulio Francesco
Proietti, Marco
Vitolo, Marco
Bonini, Niccolò
Fawzy, Ameenathul Mazaya
Ding, Wern Yew
Fauchier, Laurent
Marin, Francisco
Nabauer, Michael
Dan, Gheorghe Andrei
Potpara, Tatjana S.
Boriani, Giuseppe
Lip, Gregory Y. H.
author_sort Romiti, Giulio Francesco
collection PubMed
description BACKGROUND: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. METHODS: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. RESULTS: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. CONCLUSIONS: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-022-02526-7.
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spelling pubmed-94404922022-09-04 Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry Romiti, Giulio Francesco Proietti, Marco Vitolo, Marco Bonini, Niccolò Fawzy, Ameenathul Mazaya Ding, Wern Yew Fauchier, Laurent Marin, Francisco Nabauer, Michael Dan, Gheorghe Andrei Potpara, Tatjana S. Boriani, Giuseppe Lip, Gregory Y. H. BMC Med Research Article BACKGROUND: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. METHODS: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. RESULTS: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. CONCLUSIONS: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-022-02526-7. BioMed Central 2022-09-02 /pmc/articles/PMC9440492/ /pubmed/36056426 http://dx.doi.org/10.1186/s12916-022-02526-7 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Romiti, Giulio Francesco
Proietti, Marco
Vitolo, Marco
Bonini, Niccolò
Fawzy, Ameenathul Mazaya
Ding, Wern Yew
Fauchier, Laurent
Marin, Francisco
Nabauer, Michael
Dan, Gheorghe Andrei
Potpara, Tatjana S.
Boriani, Giuseppe
Lip, Gregory Y. H.
Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry
title Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry
title_full Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry
title_fullStr Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry
title_full_unstemmed Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry
title_short Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry
title_sort clinical complexity and impact of the abc (atrial fibrillation better care) pathway in patients with atrial fibrillation: a report from the esc-ehra eurobservational research programme in af general long-term registry
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9440492/
https://www.ncbi.nlm.nih.gov/pubmed/36056426
http://dx.doi.org/10.1186/s12916-022-02526-7
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