Abstract
Clinical outcomes of patients with atrial fibrillation (AF) can be improved by an integrated care approach. We analyzed whether adherence with the AF Better Care (ABC) pathway for integrated care management would reduce the risk of dementia in a nationwide AF cohort. Using the National Health Insurance Service database of Korea, 228,026 non-valvular AF patients were retrospectively evaluated between 2005 and 2015. Patients meeting all criteria of the ABC pathway were classified as the “ABC” group and those not classified as the “non-ABC” group. During a median (25th, 75th percentiles) follow-up of 6.0 (3.3, 9.5) years, the ABC group had lower rates and risk of overall dementia (0.17 vs. 1.11 per 100 person-years, p < 0.001; hazard ratio (HR) 0.80; 95% CI 0.73–0.87) and both Alzheimer’s (HR 0.79, 95% CI 0.71–0.88) and vascular dementia (HR 0.76, 95% CI 0.59–0.98) than the non-ABC group. The stratified analysis showed that the ABC pathway reduced the risk of dementia regardless of sex, comorbidities, and in patients with high stroke risk. Adherence with the ABC pathway is associated with a reduced risk of dementia in AF patients. Due to the high medical burden of AF, it is necessary to implement integrated AF management to reduce the risk of dementia.
Highlights
Atrial fibrillation (AF) is the most common cardiac arrhythmia and is a substantial economic and public health burden [1,2]
Population-based benefits for total dementia, Alzheimer’s, or vascular dementia due to adherence to the AF Better Care (ABC) pathway in AF pathway patients have not been previously assessed in AF patients
Given the close association between AF and dementia, this study aimed to evaluate whether compliance with the ABC pathway would improve the risk of dementia in patients with AF
Summary
Atrial fibrillation (AF) is the most common cardiac arrhythmia and is a substantial economic and public health burden [1,2]. The ABC (atrial fibrillation Better Care) pathway has been proposed as such a simple and holistic integrated approach [13]. This pathway facilitates the care pathway as follows: “A”—avoid stroke with optimal anticoagulation; “B”—better symptom management; and “C”—cardiovascular and comorbidity management [13]. The application of the simple ABC pathway was associated with a lower risk of all-cause death and the composite outcome included all-cause death, ischemic stroke, myocardial infarction, or major bleeding in patients with AF [14,15,16]. Given the close association between AF and dementia, this study aimed to evaluate whether compliance with the ABC pathway would improve the risk of dementia in patients with AF
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