Comprehensive Management With the ABC (Atrial Fibrillation Better Care) Pathway in Clinically Complex Patients With Atrial Fibrillation: A Post Hoc Ancillary Analysis From the AFFIRM Trial

Background For patients with atrial fibrillation, a comprehensive care approach based on the Atrial fibrillation Better Care (ABC) pathway can reduce the occurrence of adverse outcomes. The aim of this paper was to investigate if an approach based on the ABC pathway is associated with a reduced risk...

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Published in:Journal of the American Heart Association Vol. 9; no. 10; p. e014932
Main Authors: Proietti, Marco, Romiti, Giulio Francesco, Olshansky, Brian, Lane, Deirdre A., Lip, Gregory Y. H.
Format: Journal Article
Language:English
Published: England John Wiley and Sons Inc 18.05.2020
Wiley
Subjects:
Aged
Anticoagulants - adverse effects
Anticoagulants - therapeutic use
atrial fibrillation
Atrial Fibrillation - diagnosis
Atrial Fibrillation - mortality
Atrial Fibrillation - therapy
Clinical Decision-Making
Critical Pathways
Female
Hospitalization
Humans
integrated care
Male
Multimorbidity
Original Research
outcomes research
Patient-Centered Care
Polypharmacy
Risk Assessment
Risk Factors
Stroke - diagnosis
Stroke - mortality
Stroke - prevention & control
Time Factors
Treatment Outcome
integrated care
atrial fibrillation
outcomes research
ISSN:2047-9980, 2047-9980
Online Access:Get full text
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Summary:Background For patients with atrial fibrillation, a comprehensive care approach based on the Atrial fibrillation Better Care (ABC) pathway can reduce the occurrence of adverse outcomes. The aim of this paper was to investigate if an approach based on the ABC pathway is associated with a reduced risk of adverse events in "clinically complex" atrial fibrillation patients, including those with multiple comorbidities, polypharmacy, and prior hospitalizations. Methods and Results We performed a post hoc analysis of the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial. The principal outcome was the composite of all-cause hospitalization and all-cause death. An integrated care approach (ABC group) was used in 3.8% of the multimorbidity group, 4.0% of the polypharmacy group, and 4.8%, of the hospitalized groups. In all "clinically complex" groups, the cumulative risk of the composite outcome was significantly lower in patients managed consistent with the ABC pathway versus non-ABC pathway-adherent (all <0.05). Cox regression analysis showed a reduction of composite outcomes in ABC pathway-adherent versus non-ABC pathway-adherent for multimorbidity (hazard ratio [HR], 0.61, 95% CI, 0.44-0.85), polypharmacy (HR, 0.68, 95% CI, 0.47-1.00), and hospitalization (HR, 0.59, 95% CI, 0.42-0.85) groups. Secondary analyses showed that the higher number of ABC criteria fulfilled the larger associated reduction in relative risk, even for secondary outcomes considered. Conclusions Use of an ABC consistent pathway is associated with fewer major adverse events in patients with atrial fibrillation who have multiple comorbidities, use of polypharmacy, and prior hospitalization.
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For Sources of Funding and Disclosures, see page 10.
This article was handled independently by Marwan Refaat, MD as a guest editor. The editors had no role in the evaluation of the manuscript or in the decision about its acceptance.
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.119.014932