Atrial Fibrillation Better Care Pathway Research Articles

Relation of changes in ABC pathway compliance status to clinical outcomes in patients with atrial fibrillation: A report from the COOL-AF registry.

The Atrial fibrillation Better Care (ABC) pathway provides a framework for holistic care management of atrial fibrillation (AF) patients. This study aimed to determine the impact of changes in compliance to ABC pathway management on clinical outcomes. This is a prospective multicenter AF registry. Patients with non-valvular AF were enrolled and follow-up for 3 years. Baseline and follow-up compliance to the ABC pathway was assessed. The main outcomes were all-cause death, ischemic stroke/systemic embolism (SSE), major bleeding, and heart failure. There studied 3096 patients (mean age 67.6±11.1 years, 41.8% female). Patients were categorized into 4 groups: Group 1: ABC compliant at baseline and 1 year [n=1022 (33.0%)]; Group 2: ABC non-compliant at baseline but compliant at 1 year [n=307 (9.9%)]; Group 3: ABC compliant at baseline and non-compliant at 1 year [n=312 (10.1%)]; and Group 4: ABC non-compliant at baseline and also at 1 year [n=1455 (47.0%)]. The incidence rates (95% confidence intervals, CI) of the composite outcome for Group 1 to 4 were 5.56 (4.54-6.74), 7.42 (5.35-10.03), 9.74 (7.31-12.70), and 11.57 (10.28-12.97), respectively. With Group 1 as a reference, Group 2-4 had hazard ratios (95% CI) of the composite outcome of 1.32 (0.92-1.89), 1.75 (1.26-2.43), and 2.07 (1.65-2.59), respectively. Re-evaluation of compliance status of the ABC pathway management is needed to optimize integrated care management and improve clinical outcomes. AF patients who were ABC pathway compliant at baseline and also at follow-up had the best clinical outcomes.

2024 Chinese expert consensus guidelines on the diagnosis and treatment of Atrial Fibrillation in the Elderly. Executive Summary.

The consensus guidelines of the Geriatric Society of Chinese Medical Association (GSCMA) on the management of atrial fibrillation (AF) in the elderly was first published in 2011 and updated in 2016, with endorsement by Chinese Society of Geriatric Health Medicine (CSGHM). Since then, many important studies regarding the screening and treatment in the elderly population have been reported, necessitating this updated expert consensus guidelines. The writing committee members comprehensively reviewed updated evidence pertaining to elderly patients with AF, and formulated this 2024 update. The highlighted issues focused on the following: screening for AF, geriatric comprehensive assessment, use of the Atrial fibrillation Better Care (ABC) pathway for the elderly patients, and special clinical settings related to elderly patients with AF. New recommendations addressing smart technology facilitated AF screening, ABC pathway based management and optimal anticoagulation were developed, with a focus on the elderly.

Educational status and the risk of adverse outcomes in Asian patients with atrial fibrillation: a report from the prospective APHRS-AF Registry.

The aim of this study was to evaluate the impact of educational status (ES) on the clinical course of Asian patients with atrial fibrillation (AF). We used data from the prospective APHRS-AF Registry. ES was classified as follows: low (primary school), medium (secondary), and high (University). The primary outcome was a composite of all-cause death, thromboembolic events, acute coronary syndrome, and heart failure. Secondary outcomes were each component of the primary outcome, cardiovascular death, and major bleeding. The one-year risk of primary and secondary outcomes was assessed through Cox-regressions. Adherence to the Atrial fibrillation Better Care (ABC) pathway was assessed. Among 2697 AF patients (69±12 years, 34.8% females), 34.6% had low ES; 37.3% had medium ES; and 28.1% had high ES. Compared to patients with medium-high ES, patients with low ES were older, more often females, with a higher prevalence of cardiovascular risk factors, and a lower ABC pathway adherence (30.4% vs. 40.2%, P<0.001). On multivariable analysis, low ES was associated with a higher risk for the primary outcome (HR 1.52,95%CI 1.11-2.06) and all-cause death (HR 1.76,95%CI 1.10-2.83) than medium-high ES. A significant interaction was found for the risk of composite outcome among the different age strata, with the higher risk in the elderly (P for int=0.008), whereas the beneficial effect of the ABC pathway was irrespective of ES (P for int=0.691). In Asian AF patients, low ES is associated with high mortality. Efforts to improve education and include ES evaluation in the integrated care approach for AF are necessary to reduce the cardiovascular burden in these patients.

Adherence to the atrial fibrillation better care pathway and its associated factors among rural patients with atrial fibrillation in China: A cross-sectional study

BackgroundThe atrial fibrillation better care (ABC) pathway is an effective strategy for the integrated management of atrial fibrillation (AF). Current data on adherence to the ABC pathway among rural patients with AF in China are limited. ObjectivesTo investigated adherence to the ABC pathway and its associated factors among rural patients with AF in China. MethodsIn the cross-sectional study, we recruited 870 rural patients with AF from July 2022 to July 2023 in China. AF-related sociodemographic and clinical data was collected. ResultsAmong the 870 rural patients with AF, 437 (50.23 %) were male, 714 (82.07 %) were ≥65 years old. The level of adherence to ABC pathway was extremely low (5.75 %), and its associated factors included patients ≥75 years (compared with those <65 years, OR=0.165, 95 %CI: 0.065–0.417, P < 0.001), junior middle school and senior middle school education or above (compared with primary school education or below, OR=3.441, 95 %CI: 1.144–10.351, P = 0.028; OR=11.438, 95 %CI: 3.758–34.814, P < 0.001), average monthly household income per capita 1000–3000 RMB and >3000 RMB (compared with <1000 RMB, OR=3.993, 95 %CI: 1.343–11.877, P = 0.013; OR=4.474, 95 %CI: 1.478–13.541, P = 0.008), persistent AF (compared with paroxysmal AF, OR=0.062, 95 %CI: 0.008–0.466, P = 0.007) and multimorbidity (OR=0.356, 95 %CI: 0.163–0.781, P = 0.010). ConclusionsThere is an urgent need to develop targeted interventions and national policies to improve the adherence to the ABC pathway of rural AF patients in China.

Adherence to the Atrial fibrillation Better Care pathway and the risk of adverse health outcomes in older care home residents with atrial fibrillation: a retrospective data linkage study 2003-18.

The Atrial fibrillation Better Care (ABC) pathway is the gold-standard approach to atrial fibrillation (AF) management, but the effect of implementation on health outcomes in care home residents is unknown. To examine associations between ABC pathway adherence and stroke, transient ischaemic attack, cardiovascular hospitalisation, major bleeding, mortality and a composite of all these outcomes in care home residents. A retrospective cohort study of older care home residents (≥65years) in Wales with AF was conducted between 1 January 2003 and 31 December 2018 using the Secure Anonymised Information Linkage Databank. Adherence to the ABC pathway was assessed at care home entry using pre-specified definitions. Cox proportional hazard and competing risk models were used to estimate the risk of health outcomes according to ABC adherence. From 14,493 residents (median [interquartile range] age 87.0 [82.6-91.2] years, 35.2% male) with AF, 5,531 (38.2%) were ABC pathway adherent. Pathway adherence was not significantly associated with risk of the composite outcome (adjusted hazard ratio, 95% confidence interval [CI]: 1.01 [0.97-1.05]). There was a significant independent association observed between ABC pathway adherence and a reduced risk of myocardial infarction (0.70 [0.50-0.98]), but a higher risk of haemorrhagic stroke (1.59 [1.06-2.39]). ABC pathway adherence was not significantly associated with any other individual health outcomes examined. An ABC adherent approach in care home residents was not consistently associated with improved health outcomes. Findings should be interpreted with caution owing to difficulties in defining pathway adherence using routinely collected data and an individualised approach is recommended.

ABC (Atrial fibrillation Better Care) pathway in asian patients: an analysis from the prospective Asia-Pacific Heart Rhythm Society Atrial Fibrillation Registry

Abstract Introduction The "Atrial fibrillation Better Care" (ABC) has been proposed as an integrated approach to improve management in patients with atrial fibrillation (AF) based on 3 pillars: "A" Avoid stroke with Anticoagulation; "B" Better symptom optimisation through rate or rhythm control; "C" Cardiovascular risk factor management. There are limited prospective data on the clinical outcomes associated with ABC pathway adherence from Asian countries. Purpose To investigate the beneficial effect of ABC pathway adherence in the prospective multi-country Asia-Pacific Heart Rhythm Society (APHRS) Atrial Fibrillation registry. Method We investigated 4013 AF patients prospectively enrolled in the APHRS registry. Cox-regression analyses were performed to investigate the association between ABC adherence and clinical outcomes. Primary outcome was a composite of all-cause death, any thromboembolic events, acute coronary syndrome or percutaneous interventional procedures and new/worsening heart failure. Secondary outcomes were each component of the composite outcome and major bleeding. Results In the whole population, 1549 (38.6%) patients were ABC adherent (mean age 66±12 years; 33% female). After 1-year of follow-up, ABC pathway adherent patients had a lower incidence of composite outcome (4.0% vs 8.5%, p&amp;lt;0.001), all-cause death (1.4% vs 4.0%, p&amp;lt;0.001), cardiovascular death (0.3% vs 0.9%, p=0.013) and new/worsening heart failure (1.7% vs 2.7%, p=0.010), when compared to those ABC non-adherent. On multivariable Cox regression ABC pathway adherence was associated with a lower risk for composite outcome (Hazard Ratio 0.72, 95% Confidence Interval 0.53-0.97) and the reduction of the risk increased progressively with the number of the ABC criteria fulfilled. There was no statistically significant interaction in the clinical benefit seen between the different participating countries in the APHRS registry (pint=0.217). Conclusion In a large contemporary cohort of Asian AF patients, ABC pathway adherence was associated with a reduction of the risk for the composite outcome of all-cause death and cardiovascular events. This benefit was seen irrespective of enrolling country.

Abstract 13602: Compliance With the Atrial Fibrillation Better Care (ABC) Pathway in Public and Private Healthcare Units From a Middle-Income Country

Introduction: The ABC pathway (A: Avoid stroke; B: Better symptoms; C: Comorbidities and lifestyle management) has been proposed to ensure a holistic or integrated care approach to atrial fibrillation (AF) management. There are scarce data about compliance with this strategy in low- and middle-income countries, where the AF populational burden is likely to increase. Hypothesis: Compliance with ABC pathway (ABC-compliance) in Brazil is low and associated with certain patient characteristics. Methods: We included 700 patients (46% women, 69±15 years) with confirmed AF. Participants were recruited from private and public healthcare units in São Paulo city. We built logistic regression models to analyze if age, sex, race, HAS-BLED scores, or healthcare sector (public or private) were associated with lack of ABC-compliance (Table 1). Results: ‘A’, ‘B’, ‘C’ and ABC-compliance occurred in 42%, 82%, 50%, and 21%, respectively. In multiple models (Table 2), lack of ABC-compliance was associated with female sex and high HAS-BLED scores. Lack of ‘B’ component compliance was associated with non-White race. Treatment in public units was positively associated with a lack of ‘A’ component compliance but this was inversely associated with a lack of ‘C’ component compliance. Age and ABC-compliance were not independently associated. Conclusions: Compliance with ABC pathway in our healthcare setting was low. Female sex and high HAS-BLED scores were markers of poor compliance with this integrated approach. Patients treated in private health units may have higher access to oral anticoagulants, while better comorbidity control in public health units may reflect a less segmented system of care.

Abstract 18371: Evaluation of the Atrial Fibrillation Better Care Pathway in Patients With Atrial Fibrillation: A Machine Learning Cluster Analysis

Background: Atrial fibrillation Better Care (ABC) pathway is recommended by guidelines on atrial fibrillation (AF) and exerts a protective role against adverse outcomes of AF patients. We hypothesize that cluster analysis, an unsupervised machine learning technique, could comprehensively evaluate multiple clinical characteristics of patients, and define clusters of ABC criteria efficacy in patients with AF. Methods: We used data from an observational cohort that included 2,016 patients with AF. We utilized 46 baseline variables for cluster analysis and got the optimal clusters through the K-prototypes algorithm. We evaluated the management patterns and adverse outcomes of identified phenotypes. We assessed the effectiveness of the ABC criteria in reducing adverse outcomes of these phenotypes. Results: Cluster analysis identified AF patients into three distinct groups with markedly different clinical characteristics and outcomes. The clusters were as followed: Cluster 1, old patients with atherosclerotic-comorbidities (n = 964); Cluster 2, young females with valve-comorbidities (n = 407), and Cluster 3, paroxysmal AF patients with low comorbidities (n = 644). The clusters showed significant differences in MACNE, all-cause death, stroke, cardiovascular death, and hospital readmission for heart failure. All clusters showed that full adherence to the ABC pathway was associated with a significant reduction in the risk of MACNE (all P&lt; 0.05). Adherence to the different ‘A’/’B’/’C’ criteria alone showed differential clinic impact for three clusters. Conclusion: Cluster analysis of the Chinese AF cohort further elucidated the heterogeneity of AF. We proposed suggestions for optimizing risk stratification and integrated management of AF patients.

Clinical phenotype classification to predict risk and optimize the management of patients with atrial fibrillation using the Atrial Fibrillation Better Care (ABC) pathway: a report from the COOL-AF registry.

Phenotypic classification is a method of grouping patients with similar phenotypes. We aimed to use phenotype classification based on a clustering process for risk stratification of patients with non-valvular atrial fibrillation (AF) and second, to assess the benefit of the Atrial Fibrillation Better Care (ABC) pathway. Patients with AF were prospectively enrolled from 27 hospitals in Thailand from 2014 to 2017, and followed up every 6 months for 3 years. Cluster analysis was performed from 46 variables using the hierarchical clustering using the Ward minimum variance method. Outcomes were a composite of all-cause death, ischemic stroke/systemic embolism, acute myocardial infarction and heart failure. A total of 3405 patients were enrolled (mean age 67.8 ± 11.3 years, 58.2% male). During the mean follow-up of 31.8 ± 8.7 months. Three clusters were identified: Cluster 1 had the highest risk followed by Cluster 3 and Cluster 2 with a hazard ratio (HR) and 95% confidence interval (CI) of composite outcomes of 2.78 (2.25, 3.43), P < 0.001 for Cluster 1 and 1.99 (1.63, 2.42), P < 0.001 for Cluster 3 compared with Cluster 2. Management according to the ABC pathway was associated with reductions in adverse clinical outcomes especially those who belonged to Clusters 1 and 3 with HR and 95%CI of the composite outcome of 0.54 (0.40, 073), P < 0.001 for Cluster 1 and 0.49 (0.38, 0.63), P < 0.001 for Cluster 3. Phenotypic classification helps in risk stratification and prognostication. Compliance with the ABC pathway was associated with improved clinical outcomes.

Non-vitamin K Antagonist Oral Anticoagulant, Warfarin, and ABC Pathway Adherence on Hierarchical Outcomes: Win Ratio Analysis of the COOL-AF Registry.

Atrial fibrillation (AF) Better Care (ABC) pathway adherence is associated with improved outcomes. Clinical trials have shown that non-vitamin K antagonist oral anticoagulants (NOACs) are as least as effective as warfarin for stroke prevention in AF patients. The Win Ratio method, analyzing hierarchical composite outcomes considering event timing and severity, has limited data on its use in Asians. We aim to apply Win Ratio in a registry to access the comparative effectiveness of NOACs versus warfarin and ABC adherence versus nonadherence in Asian patients with AF. Our study included nonvalvular AF patients from the nationwide prospective COOL-AF registry in Thailand. The NOAC-treated group was compared with the warfarin-treated group using the Win Ratio, with the following order: all-cause death, intracranial hemorrhage (ICH), ischemic stroke/transient ischemic attack/systemic embolism, non-ICH major bleeding, and myocardial infarction or heart failure. ABC pathway adherence versus nonadherence was also compared. A Win Ratio greater than 1.00 indicating a better outcome. The analysis included 2,568 patients, with 228 in the NOAC group and 2,340 in the warfarin group. The NOAC group had more wins than the warfarin group, with an unmatched Win Ratio of 1.64 (95% confidence interval [CI]: 1.22-2.20; p < 0.001). When compared with nonadherence, ABC pathway adherence was associated with a Win Ratio of 1.57 (95% CI: 1.33-1.85; p < 0.001). This Win Ratio analysis demonstrates the significant benefits of NOACs over warfarin and ABC pathway adherence over nonadherence in reducing the composite outcome in patients with AF.

Adherence to Atrial Fibrillation Better Care (ABC) Pathway Management of Chinese Community Elderly Patients with Atrial Fibrillation: A Cross-Sectional Study.

Investigating adherence to the Atrial Fibrillation Better Care (ABC) pathway management and identifying gaps between the real world and established guidelines can lead to better integrated management of AF. Current data on adherence to ABC pathway management among community elderly patients with atrial fibrillation (AF) in Chinese communities is limited. To investigate the adherence to ABC pathway management among community elderly patients with AF in China. In this cross-sectional study, data were collected from the 2020 National Basic Public Health Service Program database that includes health examination information for all residents >65 years of age in Yuexiu, Guangzhou, Guangdong Province. Demographic and clinical characteristics data from 197 community AF patients were obtained. Among the 197 AF patients, 103 (52.3%) were male, 117 (59.4%) were ≥75 years of age, 127 (64.5%) had a senior middle school education or above, 84.3% were married, and 195 (99.0%) had medical insurance. The most common comorbidities were hypertension (72.1%, 142/197), dyslipidaemia (28.4%, 56/197), CAD (28.9%, 57/197), and diabetes (24.9%, 49/197). In terms of the ABC management pathway, 21.8% (43/197), 82.7% (163/197), and 31.5% (62/197) of AF patients were classified into the A-adherent group, B-adherent group, and C-adherent group, respectively. The level of adherence to ABC pathway management was very low (9.1%, 18/197) and independently associated with age and multimorbidity. The level of adherence to ABC pathway management in community elderly patients with AF was unsatisfactory.Further research is warranted to improve the integrated management of AF.

Integrated Care for Atrial Fibrillation Using the ABC Pathway in the Prospective APHRS-AF Registry

BackgroundThe Atrial Fibrillation Better Care (ABC) has been proposed as an integrated approach to improve management in patients with atrial fibrillation (AF), based on 3 pillars: “A” Avoid stroke with Anticoagulation; “B” Better symptoms control; “C” Cardiovascular risk-factor and comorbidities management. ObjectivesThis study sought to investigate the association with outcomes of ABC adherence in the prospective multinational Asia-Pacific Heart Rhythm Society (APHRS) Atrial Fibrillation registry. MethodCox-regression analyses adjusted for age, sex, CHA2DS2-VASc score, paroxysmal AF, chronic obstructive pulmonary disease, chronic kidney disease, cancer, dyslipidemia, and dementia were performed to investigate the association with outcomes. Primary outcome was a composite of all-cause death, any thromboembolic events, acute coronary syndrome or percutaneous interventional procedures, and advancing heart failure. ResultsOf the 4,013 included patients with AF (mean age 68 ± 12 years; 34.4% female); 38.6% were adherent to all 3 main ABC pillars. After 1 year of follow-up, adherence to the ABC pathway was associated with a low incidence of composite outcome (4.0% vs 8.5%, P < 0.001), all-cause and cardiovascular death, and advancing heart failure. On Cox regression analysis, ABC adherence was associated with a lower risk of primary outcome (HR: 0.72; 95% CI: 0.53-0.97), with risk reduction progressively higher with a higher number of ABC criteria attained. No significant interaction in the association was seen according to the different geographic areas (Pint = 0.217). ConclusionsIn a large contemporary cohort of Asian patients with AF, adherence to ABC pathway was associated with a reduction of the risk for adverse outcomes. (Clinical Survey on the Stroke Prevention in Atrial Fibrillation in Asia (AF-Registry; NCT04807049)

Effects of the ABC pathway on clinical outcomes in a secondary prevention population of Chinese patients with atrial fibrillation: A report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry.

The atrial fibrillation better care (ABC) pathway is a simple, comprehensive framework that facilitates provision of integrated care for atrial fibrillation (AF) patients. We evaluated management of AF patients in a secondary prevention cohort using the ABC pathway and examined the impact of ABC adherence on clinical outcomes. The Chinese Patients with Atrial Fibrillation registry is a prospective registry conducted in 44 sites across China between October 2014 and December 2018. The primary outcome was the composite of all-cause mortality/any thromboembolism (TE), all-cause death, any TE and major bleeding at 1 year. Of the 6420 patients, 1588 (24.7%) had a prior stroke or transient ischemic attack and were identified as the secondary prevention cohort. After excluding 793 patients due to insufficient data, 358 (22.5%) were ABC compliant and 437 (27.5%) ABC noncompliant. ABC adherence was associated with a significantly lower risk of the composite outcome of all-cause death/TE, odds ratio (OR) 0.28 (95% confidence interval [CI]: 0.11-0.71) and all-cause death, OR 0.29 (95% CI: 0.09-0.90). Significant differences were not observed for TE, OR 0.27 (95% CI: 0.06-1.27) and major bleeding, OR 2.09 (95% CI: 0.55-7.97). Age and prior major bleeding were significant predictors of ABC noncompliance. Health-related quality of life (QOL) was higher in the ABC compliant group versus the noncompliant group (EQ score 0.83 ± 0.17 vs. 0.78 ± 0.20; p = .004). ABC pathway adherence in secondary prevention AF patients was associated with a significantly lower risk of the composite outcome of all-cause death/TE and all-cause death, as well as better health-related QOL.

Adherence to the Atrial Fibrillation Better Care (ABC) pathway and the risk of major outcomes in patients with atrial fibrillation: A post-hoc analysis from the prospective GLORIA-AF Registry.

The 'Atrial fibrillation Better Care' (ABC) pathway has been proposed to streamline a more holistic or integrated care approach to atrial fibrillation (AF) management. We aimed to analyse the impact of adherence to the ABC pathway on the risk of major adverse outcomes in a contemporary prospective global cohort of patients with AF. Patients enrolled Phase II and III of the GLORIA-AF Registry with complete data on ABC pathway adherence and follow-up were included in this post-hoc analysis between November 2011 and December 2014 for Phase II, and between January 2014 and December 2016 for Phase III. The primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACEs). Multivariable Cox-regression and delay of event (DoE) analyses were used to evaluate the association between adherence to the ABC pathway and the risk of outcomes. We included 24,608 patients in this analysis (mean age: 70.2 (10.3) years, 10,938 (44.4%) females). Adherence to the ABC pathway was associated with a significant risk reduction for the primary outcome, with greatest magnitude observed for full ABC pathway adherence (adjusted Hazard Ratio [aHR] 0.54, 95% Confidence Interval [CI]: 0.44-0.67, p<0.0001). ABC pathway adherence was also associated with reduced risk of mortality (aHR: 0.89, 95% CI: 0.79-1.00, p=0.048), thromboembolism (aHR: 0.78, 95% CI: 0.65-0.94, p=0.0078), and MACE (aHR: 0.82, 95% CI: 0.71-0.95, p=0.0071). An increasing number of ABC criteria attained was associated with longer event-free survival in the DoE analysis. Adherence to the ABC pathway in patients with AF was associated with a reduced risk of major adverse events, including mortality, thromboembolism and MACE. This underlines the importance of using the ABC pathway in the clinical care of patients with AF. This study was funded by Boehringer Ingelheim.

S-10-5: OPTIMAL BLOOD PRESSURE AND CARDIOVASCULAR RISK MANAGEMENT IN PATIENTS WITH ATRIAL FIBRILLATION

Hypertension is one of the most common cardiovascular disorders. On a population basis, and high blood pressure (BP) is a major independent risk factor for incident atrial fibrillation (AF) and AF-related complications. Given the high prevalence and both disorders being commonly asymptomatic, opportunistic arrhythmia screening in hypertensive patients is needed. In terms of management, AF could be regarded as a manifestation of hypertensive target organ damage, and optimal BP control is recommended, ideally aiming for a target systolic BP of 120–129mmHg, and diastolic BP of &lt; 80mmHg. There is a close link between hypertension and the risk of stroke in AF, as well as the risk of serious bleeds in anticoagulated AF patients. Also, hypertension burden can be related to other AF-related complications, such as dementia and end renal disease. BP control should also be complementary to lifestyle factors, such as weight reduction, smoking cessation, alcohol reduction and regular exercise, given the close association with incident AF and AF-related complications such as stroke, major adverse cardiac events (MACE) and heart failure. Contemporary management of AF has moved towards a more holistic or integrated care approach to AF management, summed up as the ABC (Atrial fibrillation Better Care) pathway: A/Avoid stroke with Anticoagulation; B/ Better symptom control with patient-centred symptom-directed decisions on rate or rhythm control; and C/Cardiovascular risk and comorbidity management, including lifestyle changes. Adherence to the ABC pathway is associated with a profound reduction in death, hospitalisation, stroke and bleeding in AF patents [Fgure]. In summary, increased awareness, diagnosis and proactive management of detected hypertension is crucial in patients with AF. Optimised blood pressure control is an essential component of such a holistic approach to AF care.

328 IMPACT OF INTEGRATED CARE WITH ABC PATHWAY IN PATIENTS WITH ATRIAL FIBRILLATION AND HEART FAILURE: DATA FROM MORE THAN 11000 PATIENTS ENROLLED IN A EUROPEAN REGISTRY

Abstract Background and aim Heart failure (HF) is closely associated with atrial fibrillation (AF). The Atrial fibrillation Better Care (ABC) pathway is recommended in guidelines as a holistic or integrated care approach to AF management. However, few data are specifically available on ABC pathway adherence in AF patients with HF, especially according to HF phenotypes. Therefore, we aimed to retrospectively investigate the effect of ABC management in a large contemporary cohort of AF patients with HF and the impact on the clinical outcomes. Methods We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. According to the availability of HF status and ejection fraction (EF) values, patients were categorized as follows: i) non-HF; ii) HF EF&amp;gt;40% iii) HF EF≤40%. The primary outcome was a composite outcome of all-cause death and major adverse cardiac events. Results Among the original 11 096 AF patients enrolled, 9175 (82.7%) were included in this analysis (median age 71 years, interquartile range [IQR 63-77], 40.1% were female, with median EF 55% [IQR 45-61%] and median CHA2DS2-VASc 3 [2-4]). In this cohort, 5935 (64.7%) were non-HF patients, and 3240 (35.3%) had HF patients. According to the EF values, 2005 (65%) were categorized as HF EF&amp;gt;40%, and 1235 (35%) were HF EF≤40%. Overall, ABC pathway adherence in HF patients was 23.3% [95% CI: 21.6-25.2], being higher in HF EF≤40% patients (28.0%) and lower in HF EF&amp;gt;40% ones (21.9%). After a median follow-up of 731[IQR 690-748] days, ABC adherence was associated with a lower risk for the composite outcome compared to non-ABC adherent patients in each HF group (HF EF&amp;gt;40%: ABC 15.4% vs no ABC 20.9%; HF EF≤40%: ABC 20.3% vs no ABC 33.9%; both p&amp;lt;0.001). Cox regression analysis showed that ABC adherence was associated with a lower risk of composite outcome in each HF category (HF EF&amp;gt;40%: HR 0.66 [95% CI: 0.46-0.96], p=0.030; HF EF≤40%: HR 0.60 [95% CI: 0.40-0.90], p=0.013). ABC adherence was associated with a consistent risk reduction for the composite outcome across the entire EF spectrum [Figure]. Conclusions In this large contemporary cohort of AF-HF patients, adherence to the ABC pathway was associated with a lower occurrence of the primary outcome, irrespective of baseline EF. ABC pathway is consistently associated with a lower risk for adverse outcomes across the entire spectrum of EF.

Natural history of ‘silent’ atrial fibrillation from subclinical to asymptomatic: State of the art and need for research

In the last 30 years clinical research in the atrial fibrillation (AF) field has seen a great advance both in terms of productivity and heterogeneity of areas that developed significant new knowledge and evidence. Indeed, it is very easy to verify how in the last 3 decades the number of articles regarding AF registered in MEDLINE has increased exponentially overtime. This large amount of evidence led to significant changes in the guidelines, with an improvement of the overall quality of recommendations and an increase in the high-quality recommendations (despite being still generally low) [ [1] Boriani G. Vitolo M. Lane D.A. Potpara T.S. Lip G.Y. Beyond the 2020 guidelines on atrial fibrillation of the European society of cardiology. Eur J Intern Med. 2021; 86: 1-11https://doi.org/10.1016/j.ejim.2021.01.006 Google Scholar , [2] Barnett A.S. Lewis W.R. Field M.E. Fonarow G.C. Gersh B.J. Page R.L. et al. Quality of evidence underlying the American Heart Association/American College of Cardiology/Heart Rhythm Society Guidelines on the management of atrial fibrillation. JAMA Cardiol. 2017; 2: 319https://doi.org/10.1001/jamacardio.2016.4936 Google Scholar ]. Several areas about AF clinical management are now largely assessed and established, as the need for oral anticoagulant (OAC) prescription, the preference of the non-vitamin K antagonist oral anticoagulants over vitamin k antagonist ones, as well as the assessment of thromboembolic and bleeding risks [ [3] Imberti J.F. Mei D.A. Vitolo M. Bonini N. Proietti M. Potpara T. et al. Comparing atrial fibrillation guidelines: focus on stroke prevention, bleeding risk assessment and oral anticoagulant recommendations. Eur J Intern Med. 2022; 101: 1-7https://doi.org/10.1016/j.ejim.2022.04.023 Google Scholar , [4] Hindricks G. Potpara T. Dagres N. Arbelo E. Bax J.J. Blomström-Lundqvist C. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021; 42: 373-498https://doi.org/10.1093/eurheartj/ehaa612 Google Scholar ]. Also, the need for implementation of integrated care, emerged as the main AF management strategy in the last guidelines, is now largely assessed and evidence based [ 4 Hindricks G. Potpara T. Dagres N. Arbelo E. Bax J.J. Blomström-Lundqvist C. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021; 42: 373-498https://doi.org/10.1093/eurheartj/ehaa612 Google Scholar , 5 Romiti G.F. Pastori D. Rivera-Caravaca J.M. Ding W.Y. Gue Y.X. Menichelli D. et al. Adherence to the “atrial fibrillation better care” pathway in patients with atrial fibrillation: impact on clinical outcomes-a systematic review and meta-analysis of 285,000 patients. Thromb Haemost. 2022; 122: 406-414https://doi.org/10.1055/a-1515-9630 Google Scholar , 6 Romiti G.F. Proietti M. Vitolo M. Bonini N. Fawzy A.M. Ding W.Y. et al. Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry. BMC Med. 2022; 20: 326https://doi.org/10.1186/s12916-022-02526-7 Google Scholar ].

Impact of ABC (Atrial Fibrillation Better Care) pathway adherence in high-risk subgroups with atrial fibrillation: A report from the ESC-EHRA EORP-AF long-term general registry

BackgroundEffects of Atrial Fibrillation Better Care (ABC) adherence among high-risk atrial fibrillation (AF) subgroups remains unknown. We aimed to evaluate the impact of ABC adherence on clinical outcomes in these high-risk patients. MethodsEORP-AF General Long-Term Registry is a prospective, observational registry from 250 centres across 27 European countries. High-risk patients were defined as those with either CKD (eGFR <60 mL/min/1.73m2), elderly patients (≥75 years) or prior thromboembolism. Primary outcome was a composite event of all-cause death, thromboembolism and acute coronary syndrome. Results6646 patients with AF were screened (median age was 70 [IQR 61 – 77] years; 40.2% females). There were 3304 (54.2%) patients with either CKD (n = 1750), older age (n = 2236) or prior thromboembolism (n = 728). Among these, 924 (28.0%) were managed as adherent to ABC. At 2-year follow-up, 966 (14.5%) patients reported the primary outcome. The incidence of the primary outcome was significantly lower in high-risk patients managed as adherent to ABC pathway (IRR 0.53 [95%CI, 0.43 – 0.64]). Consistent results were obtained in the individual subgroups. Using multivariable Cox proportional hazards analysis, ABC adherence in the high-risk cohort was independently associated with a lower risk of the primary outcome (aHR 0.64 [95%CI, 0.51 – 0.80]), as well as in the CKD (aHR 0.51 [95%CI, 0.37 – 0.70]) and elderly subgroups (aHR 0.69 [95%CI, 0.53 – 0.90]). Overall, there was greater reduction in the risk of primary outcome as more ABC criteria were fulfilled, both in the overall high-risk patients (aHR 0.39 [95%CI, 0.25 – 0.61]), as well as in the individual subgroups. ConclusionIn a large, contemporary cohort of patients with AF, we demonstrate that adherence to the ABC pathway was associated with a significant benefit among high-risk patients with either CKD, advanced age (≥75 years old) or prior thromboembolism.

Impact of ABC pathway adherence in high-risk patients with atrial fibrillation: an analysis from the ESC-EHRA EORP-AF long-term general registry

Abstract Background The impact of Atrial Fibrillation Better Care (ABC) pathway adherence among high-risk subgroups of patients with atrial fibrillation (AF), ie. those with chronic kidney disease (CKD), advanced age and/or prior thromboembolism remains unknown. We evaluated the impact of ABC pathway adherence on clinical outcomes in these high-risk AF patients. Methods The EORP-AF General Long-Term Registry is a prospective, observational registry from 250 centres across 27 European countries. High-risk patients were defined as those with either CKD (eGFR &amp;lt;60 mL/min/1.73 m2), older age (≥75 years) and/or prior thromboembolism. The primary outcome was a composite event of all-cause death, any thromboembolism and acute coronary syndrome, evaluated according to ABC pathway adherence. Results A total of 6646 patients with AF were included (median age was 70 [IQR 61–77] years; 40.2% females). There were 3304 (54.2%) `high risk' patients with either CKD (n=1750), older age (n=2236) or prior thromboembolism (n=728). Among these there were 924 (28.0%) managed as adherent to ABC. At 2-year follow-up, a total of 966 (14.5%) patients reported the primary outcome. The incidence of the primary outcome was significantly lower in high-risk patients managed as adherent to ABC pathway (IRR 0.53 [95% CI, 0.43–0.64]). Consistent results were obtained in the individual subgroups [Table]. Using multivariable Cox proportional hazards analysis, ABC adherence in the high-risk cohort was independently associated with a lower risk of primary outcome (aHR 0.64 [95% CI, 0.51–0.80]), as well as in the CKD (aHR 0.51 [95% CI, 0.37–0.70]) and elderly subgroups (aHR 0.69 [95% CI, 0.53–0.90]). Overall, there was greater reduction in the risk of primary outcome as more ABC criteria were fulfilled, both in the overall high-risk patients, as well as in the individual subgroups [Figure]. Conclusion In a large, contemporary European AF cohort there was a significant proportion of high-risk patients. Among these, a low prevalence of integrated care, as assessed by adherence to ABC pathway, was found. Nonetheless, a clinical management adherent to the ABC pathway was associated with a significant reduction in the risk of adverse outcomes, the benefits of which were more significant with increasing number of ABC criteria adherent. Funding Acknowledgement Type of funding sources: None.

ABC adherence and impact of optimal medical therapy in heart failure patients with atrial fibrillation

Abstract Background Heart failure (HF) has close association with atrial fibrillation (AF). The ESC guideline recommended Atrial fibrillation Better care (ABC) pathway aims to reduce major cardiovascular adverse outcomes with an integrated care approach. Optimal medical treatment (OMT) represents the cornerstone in HF management. Purpose To investigate the variables affecting OMT treatment and its impact, in conjunction with ABC pathway adherence (vs non-adherence, ie.no ABC), in a large contemporary cohort of European AF patients with HF enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Methods OMT was defined as treatment with Angiotensin-converting-enzyme inhibitors (ACE-i)/ Angiotensin receptor blockers (ARBs) with Beta-Blockers and/or Mineralocorticoid receptor antagonists (MRAs), and compared to non-OMT adherence (“no OMT”). A logistic regression analysis explored factors associated with OMT adherence. We identified three patient groups: (i) HF with no OMT/no ABC; (ii) HF with OMT/no ABC; (iii) HF with OMT/ABC. Primary outcome was a composite outcome of all-cause death and major adverse cardiac events (MACE). Results Among the original 11096 patients enrolled, 9857 (88.8%) were included in this analysis. Among these, 3819 (38.7%) had HF. Compared to non HF patients, those with HF were older, more likely female, had more comorbidities and higher thromboembolic risk. OMT prevalence was 2228/3819 (58.3%), while ABC adherence was 23.3%. On logistic multivariable regression, increasing age, higher BMI and higher frailty index were associated with OMT adherence, while male sex, anemia, renal disease and EHRA II–IV were inversely associated with OMT adherence. According to three HF groups, the rates of composite outcome progressively decreased (HF with no OMT/no ABC 26.4%; HF with OMT/no ABC 24%, HF with OMT/ABC 19%; p&amp;lt;0.001). Kaplan Meier curve showed progressively lower cumulative risk for the composite outcome across the three groups with the lowest risk among HF patients with OMT/ABC (Log-rank: p=0.002) [Figure 1]. Adjusted Cox regression analysis showed that when compared to HF with no OMT/no ABC group, there was a progressively lower risk with OMT and/or ABC adherence (HF with OMT/no ABC: HR 0.81 [95% CI, 0.64–1.02]; HF with OMT/ABC: HR 0.68 [95% CI, 0.5–0.92]). Conclusions After two years of follow-up, in a large contemporary cohort of European AF patients with HF, OMT adherence was suboptimal, being influenced by several clinical factors, determining a low adherence to the ABC pathway. OMT alone showed a non-significant reduction in composite outcome events. Conversely HF patients managed with OMT in the context of ABC pathway adherence showed the best reduction in risk of adverse outcomes. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Since the start of EORP, the following companies have supported the programme: Abbott Vascular Int. (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2016), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2011–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2017), Menarini Int. Op. (2009–2012), MSD-Merck &amp; Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2010–2021), and Vifor (2019–2022). - I agree that this information can be anonymised and then used for statistical purposes only