Abstract 9396: Evaluation of the ABC Pathway for Comprehensive Management of Atrial Fibrillation in 20,933 Patients from the ENGAGE AF-TIMI 48 Trial

Abstract

Introduction: Pts with atrial fibrillation (AF) are at high risk of morbidity and mortality beyond ischemic stroke. The ABC (Atrial Fibrillation Better Care) comprehensive care approach was devised to improve overall care and is endorsed by the 2020 ESC AF Guideline. The impact of the ABC pathway in a large, well-phenotyped population is unclear. Methods: ENGAGE AF-TIMI 48 was an RCT of edoxaban vs. warfarin in pts with AF and CHADS 2 score ≥2. In this exploratory analysis, pts were classified as treated according to the ABC pathway if they met all components depicted in Fig 1 . CV outcomes were compared between pts whose care was vs. was not concordant with the ABC pathway using a Cox proportional hazards model including CHA 2 DS 2 -VASc score. Randomized treatment interaction was assessed using interaction p-values. Results: Of 20,933 pts, 35% were treated concordant with the ABC pathway. These pts were younger (age <75y: 61.9% vs. 56.5%), had less frequent prior CAD (23.3% vs. 38.8%), DM (30.3% vs. 39.4%), and stroke/TIA (18.6% vs. 33.7%). Treatment consistent with the ABC pathway was associated with lower rates of stroke/SEE (HR 0.58, 95% CI 0.50-0.67), major bleeding (HR 0.71, 95% CI 0.62-0.81), MACE (HR 0.57, 95% CI 0.52-0.62), and CV death (HR 0.57, 95% CI 0.50-0.64; p<0.001 for each; Fig 2 ). Lower rates of CV events in patients treated according to the ABC pathway were generally consistent by randomized treatment. Conclusions: In this non-randomized analysis, comprehensive management of AF consistent with the ABC pathway as outlined by the 2020 ESC Guideline on AF is associated with lower adjusted rates of multiple CV outcomes including CV mortality.