Abstract
Atrial fibrillation (AF) is associated with substantially increased risk of cardiovascular events and overall mortality. The Atrial fibrillation Better Care (A—Avoid stroke, B—Better symptom management, C—Cardiovascular and comorbidity risk management) pathway provides a simple and comprehensive approach for integrated AF therapy. This study’s goals were to evaluate the ABC pathway compliance and determine the main gaps in AF management in the Middle East population, and to assess the impact of ABC pathway adherence on the all-cause mortality and composite outcome in AF patients. 2021 patients (mean age 57; 52% male) from the Gulf SAFE registry were studied. We evaluated: A—appropriate implementation of OACs according to CHA2DS2-VASc score; B—symptom control according to European Heart Rhythm Association (EHRA) symptom scale; C—proper cardiovascular comorbidities management. The primary endpoints were the composite cardiovascular outcome (ischemic stroke or systemic embolism, all-cause death and cardiovascular hospitalization) and all-cause mortality. One-hundred and sixty-eight (8.3%) patients were optimally managed according to adherence with the ABC pathway. Over the one-year follow up (FU), there were 578 composite outcome events and 224 deaths. Patients managed with integrated care had significantly lower rates for the composite outcome and mortality comparing to non-ABC group (20.8% vs. 29.3%, p = 0.02 and 7.3% vs. 13.1%, p = 0.033, respectively). On multivariable analysis, ABC compliance was independently associated with reduced risk of composite outcome (HR 0.53; 95% CI 0.36–0.8, p = 0.002) and death (HR 0.46; 95% CI 0.25–0.86, p = 0.015). Integrated ABC pathway adherent care resulted in the reduced composite outcome and all-cause mortality in AF patients from Middle East, highlighting the necessity of promoting comprehensive holistic and integrated care management of AF.
Highlights
Atrial fibrillation (AF) is the most frequent cardiac arrhythmia in clinical practice and it is influenced by various underlying risk factors [1,2]
For the first time in the Middle East region, this study evaluated if AF management that is compliant or adherent with the Atrial fibrillation Better Care (ABC) pathway was associated with improved clinical outcomes
When we analysed the relationship between partial ABC compliance and the composite outcome, AB and BC criteria together were associated with reduced risk (Table 4)
Summary
Atrial fibrillation (AF) is the most frequent cardiac arrhythmia in clinical practice and it is influenced by various underlying risk factors [1,2]. The ABC pathway provides a simple strategy for a comprehensive treatment including improvement in detection and awareness of AF, as well as dealing with AF symptoms and managing risk factors (Figure S1). Previous retrospective studies have showed the association between ABC pathway adherence and lower risk of clinical outcomes as well as decrease in health-related costs [10,11,12]. For the first time in the Middle East region, this study evaluated if AF management that is compliant or adherent with the ABC pathway was associated with improved clinical outcomes. These clinical outcomes include reducing all-cause mortality and the composite outcome of ischemic stroke or systemic embolism, all-cause death and cardiovascular hospitalization
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