Abstract
Abstract Introduction Atrial fibrillation (AF) and diabetes mellitus (DM) constitute a heavy burden on healthcare expenditure due to their negative impact on clinical outcomes in patients. DM is highly prevalent in the Middle East. The Atrial fibrillation Better Care (ABC) pathway provides a simple step-by-step strategy with an integrated, holistic approach to AF management: A, Avoid stroke (Anticoagulation); B, Better symptom management; C, Cardiovascular and comorbidity risk management. Aim Evaluation of the AF treatment compliance to ABC pathway regimen in patients with DM based on a large real-world registry from the Middle East region. We assessed the impact of ABC-pathway compliance on all-cause mortality and the composite outcome of stroke or systemic embolism, all-cause death and cardiovascular hospitalizations. Methods From 2043 patients in the Gulf SAFE registry, 603 patients with DM were included in an analysis of compliance with components of the ABC pathway: A, oral anticoagulation (OAC) use in patients with CHA2DS2-VASc score ≥1 (≥2 in females); B, AF symptoms according to the European Heart Rhythm Association (EHRA) score; C, Optimized management of cardiovascular comorbidities e.g. blood pressure control, statins for vascular disease, etc. Results From 606 patients, 86 (14.3%) patients were treated in compliance with the ABC pathway. During 1-year follow-up, 207 composite outcome events and 87 deaths occurred. Mortality was significantly lower in the ABC-adherent group vs non-ABC compliant (5.8% vs 15.9%, p=0.0014, respectively) (Figure). On multivariate analysis, ABC-adherent management was associated with a lower risk of all-cause death and the composite outcome after 6 months (OR 0.18; 95% CI, 0.42–0.75 and OR 0.54; 95% Cl, 0.30–1.00, respectively) and at 1 year (OR 0.30; 95% Cl,0.11–0.76 and OR 0.57; 95% Cl, 0.33–0.97, respectively) vs the non-ABC group (Table). Conclusions Integrated AF care, according to ABC pathway, was independently associated with a lower risk of all-cause death and the composite outcome, in DM patients with AF. This highlights the importance of a comprehensive and holistic approach to AF management. Events rates and outcomes odds ratio Funding Acknowledgement Type of funding source: None
Highlights
Atrial fibrillation (AF) and diabetes mellitus (DM) constitute a heavy burden on healthcare expenditure due to their negative impact on clinical outcomes in the Middle East
Compliance with the Atrial fibrillation Better Care (ABC) pathway care was independently associated with the reduced risk of all-cause death and the composite outcome in DM patients with AF, highlighting the importance of an integrated approach to AF management
We evaluated whether the management of AF patients with concomitant DM in the Middle East region was generally compliant with the ABC regimen, based on a ‘real-world’ dataset enrolled in the Gulf Survey of Atrial Fibrillation Events (Gulf SAFE registry)
Summary
Atrial fibrillation (AF) and diabetes mellitus (DM) constitute a heavy burden on healthcare expenditure due to their negative impact on clinical outcomes in the Middle East. ABC compliance was associated with a lower risk of all-cause death and the composite outcome after 6 months (OR 0.18; 95% CI: 0.42-0.75 and OR 0.54; 95% Cl: 0.30-1.00, respectively) and at 1 year (OR 0.30; 95% Cl: 0.11-0.76 and OR 0.57; 95% Cl: 0.33-0.97, respectively) vs the non-ABC group. Atrial Fibrillation (AF) is a leading cause of cardiovascular death as well as disability and impaired quality of life by exacerbating other underlying comorbidities such as heart failure, stroke or dementia.[1,2,3,4,5] AF is a growing epidemic is associated with high costs of treatment and hospitalisations, having significant implications for healthcare costs.[4,6,7]. By the end of 2045, the number of DM patients is expected to reach 700 million, which represents an increase by around 40%.8 the Middle East is one of the world's regions where the growth of people with diabetes is predicted to be the largest over the few years, and the prevalence is increasing[8] This is even more important given that DM is a well-established risk factor for many cardiovascular diseases, including AF.[9,10] Many studies report the common coexistence of AF and DM, and their associated cardiovascular risks.[7,11,12,13,14,15] patients with DM are more likely to develop AF during their life, but they have a significantly higher overall risk of cardiovascular complications.[16,17]
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