Cargando…

Adherence to the Atrial Fibrillation Better Care (ABC) pathway and the risk of major outcomes in patients with atrial fibrillation: A post-hoc analysis from the prospective GLORIA-AF Registry

BACKGROUND: The ‘Atrial fibrillation Better Care’ (ABC) pathway has been proposed to streamline a more holistic or integrated care approach to atrial fibrillation (AF) management. We aimed to analyse the impact of adherence to the ABC pathway on the risk of major adverse outcomes in a contemporary p...

Descripción completa

Detalles Bibliográficos
Autores principales: Romiti, Giulio Francesco, Proietti, Marco, Bonini, Niccolò, Ding, Wern Yew, Boriani, Giuseppe, Huisman, Menno V., Lip, Gregory Y.H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9706520/
https://www.ncbi.nlm.nih.gov/pubmed/36457650
http://dx.doi.org/10.1016/j.eclinm.2022.101757
_version_ 1784840521059926016
author Romiti, Giulio Francesco
Proietti, Marco
Bonini, Niccolò
Ding, Wern Yew
Boriani, Giuseppe
Huisman, Menno V.
Lip, Gregory Y.H.
author_facet Romiti, Giulio Francesco
Proietti, Marco
Bonini, Niccolò
Ding, Wern Yew
Boriani, Giuseppe
Huisman, Menno V.
Lip, Gregory Y.H.
author_sort Romiti, Giulio Francesco
collection PubMed
description BACKGROUND: The ‘Atrial fibrillation Better Care’ (ABC) pathway has been proposed to streamline a more holistic or integrated care approach to atrial fibrillation (AF) management. We aimed to analyse the impact of adherence to the ABC pathway on the risk of major adverse outcomes in a contemporary prospective global cohort of patients with AF. METHODS: Patients enrolled Phase II and III of the GLORIA-AF Registry with complete data on ABC pathway adherence and follow-up were included in this post-hoc analysis between November 2011 and December 2014 for Phase II, and between January 2014 and December 2016 for Phase III. The primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACEs). Multivariable Cox-regression and delay of event (DoE) analyses were used to evaluate the association between adherence to the ABC pathway and the risk of outcomes. FINDINGS: We included 24,608 patients in this analysis (mean age: 70.2 (10.3) years, 10,938 (44.4%) females). Adherence to the ABC pathway was associated with a significant risk reduction for the primary outcome, with greatest magnitude observed for full ABC pathway adherence (adjusted Hazard Ratio [aHR] 0.54, 95% Confidence Interval [CI]: 0.44–0.67, p < 0.0001). ABC pathway adherence was also associated with reduced risk of mortality (aHR: 0.89, 95% CI: 0.79–1.00, p = 0.048), thromboembolism (aHR: 0.78, 95% CI: 0.65–0.94, p = 0.0078), and MACE (aHR: 0.82, 95% CI: 0.71–0.95, p = 0.0071). An increasing number of ABC criteria attained was associated with longer event-free survival in the DoE analysis. INTERPRETATION: Adherence to the ABC pathway in patients with AF was associated with a reduced risk of major adverse events, including mortality, thromboembolism and MACE. This underlines the importance of using the ABC pathway in the clinical care of patients with AF. FUNDING: This study was funded by Boehringer Ingelheim.
format Online
Article
Text
id pubmed-9706520
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-97065202022-11-30 Adherence to the Atrial Fibrillation Better Care (ABC) pathway and the risk of major outcomes in patients with atrial fibrillation: A post-hoc analysis from the prospective GLORIA-AF Registry Romiti, Giulio Francesco Proietti, Marco Bonini, Niccolò Ding, Wern Yew Boriani, Giuseppe Huisman, Menno V. Lip, Gregory Y.H. eClinicalMedicine Articles BACKGROUND: The ‘Atrial fibrillation Better Care’ (ABC) pathway has been proposed to streamline a more holistic or integrated care approach to atrial fibrillation (AF) management. We aimed to analyse the impact of adherence to the ABC pathway on the risk of major adverse outcomes in a contemporary prospective global cohort of patients with AF. METHODS: Patients enrolled Phase II and III of the GLORIA-AF Registry with complete data on ABC pathway adherence and follow-up were included in this post-hoc analysis between November 2011 and December 2014 for Phase II, and between January 2014 and December 2016 for Phase III. The primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACEs). Multivariable Cox-regression and delay of event (DoE) analyses were used to evaluate the association between adherence to the ABC pathway and the risk of outcomes. FINDINGS: We included 24,608 patients in this analysis (mean age: 70.2 (10.3) years, 10,938 (44.4%) females). Adherence to the ABC pathway was associated with a significant risk reduction for the primary outcome, with greatest magnitude observed for full ABC pathway adherence (adjusted Hazard Ratio [aHR] 0.54, 95% Confidence Interval [CI]: 0.44–0.67, p < 0.0001). ABC pathway adherence was also associated with reduced risk of mortality (aHR: 0.89, 95% CI: 0.79–1.00, p = 0.048), thromboembolism (aHR: 0.78, 95% CI: 0.65–0.94, p = 0.0078), and MACE (aHR: 0.82, 95% CI: 0.71–0.95, p = 0.0071). An increasing number of ABC criteria attained was associated with longer event-free survival in the DoE analysis. INTERPRETATION: Adherence to the ABC pathway in patients with AF was associated with a reduced risk of major adverse events, including mortality, thromboembolism and MACE. This underlines the importance of using the ABC pathway in the clinical care of patients with AF. FUNDING: This study was funded by Boehringer Ingelheim. Elsevier 2022-11-24 /pmc/articles/PMC9706520/ /pubmed/36457650 http://dx.doi.org/10.1016/j.eclinm.2022.101757 Text en © 2022 The Author(s) https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Articles
Romiti, Giulio Francesco
Proietti, Marco
Bonini, Niccolò
Ding, Wern Yew
Boriani, Giuseppe
Huisman, Menno V.
Lip, Gregory Y.H.
Adherence to the Atrial Fibrillation Better Care (ABC) pathway and the risk of major outcomes in patients with atrial fibrillation: A post-hoc analysis from the prospective GLORIA-AF Registry
title Adherence to the Atrial Fibrillation Better Care (ABC) pathway and the risk of major outcomes in patients with atrial fibrillation: A post-hoc analysis from the prospective GLORIA-AF Registry
title_full Adherence to the Atrial Fibrillation Better Care (ABC) pathway and the risk of major outcomes in patients with atrial fibrillation: A post-hoc analysis from the prospective GLORIA-AF Registry
title_fullStr Adherence to the Atrial Fibrillation Better Care (ABC) pathway and the risk of major outcomes in patients with atrial fibrillation: A post-hoc analysis from the prospective GLORIA-AF Registry
title_full_unstemmed Adherence to the Atrial Fibrillation Better Care (ABC) pathway and the risk of major outcomes in patients with atrial fibrillation: A post-hoc analysis from the prospective GLORIA-AF Registry
title_short Adherence to the Atrial Fibrillation Better Care (ABC) pathway and the risk of major outcomes in patients with atrial fibrillation: A post-hoc analysis from the prospective GLORIA-AF Registry
title_sort adherence to the atrial fibrillation better care (abc) pathway and the risk of major outcomes in patients with atrial fibrillation: a post-hoc analysis from the prospective gloria-af registry
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9706520/
https://www.ncbi.nlm.nih.gov/pubmed/36457650
http://dx.doi.org/10.1016/j.eclinm.2022.101757
work_keys_str_mv AT romitigiuliofrancesco adherencetotheatrialfibrillationbettercareabcpathwayandtheriskofmajoroutcomesinpatientswithatrialfibrillationaposthocanalysisfromtheprospectivegloriaafregistry
AT proiettimarco adherencetotheatrialfibrillationbettercareabcpathwayandtheriskofmajoroutcomesinpatientswithatrialfibrillationaposthocanalysisfromtheprospectivegloriaafregistry
AT bonininiccolo adherencetotheatrialfibrillationbettercareabcpathwayandtheriskofmajoroutcomesinpatientswithatrialfibrillationaposthocanalysisfromtheprospectivegloriaafregistry
AT dingwernyew adherencetotheatrialfibrillationbettercareabcpathwayandtheriskofmajoroutcomesinpatientswithatrialfibrillationaposthocanalysisfromtheprospectivegloriaafregistry
AT borianigiuseppe adherencetotheatrialfibrillationbettercareabcpathwayandtheriskofmajoroutcomesinpatientswithatrialfibrillationaposthocanalysisfromtheprospectivegloriaafregistry
AT huismanmennov adherencetotheatrialfibrillationbettercareabcpathwayandtheriskofmajoroutcomesinpatientswithatrialfibrillationaposthocanalysisfromtheprospectivegloriaafregistry
AT lipgregoryyh adherencetotheatrialfibrillationbettercareabcpathwayandtheriskofmajoroutcomesinpatientswithatrialfibrillationaposthocanalysisfromtheprospectivegloriaafregistry
AT adherencetotheatrialfibrillationbettercareabcpathwayandtheriskofmajoroutcomesinpatientswithatrialfibrillationaposthocanalysisfromtheprospectivegloriaafregistry