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


Romiti, Giulio Francesco, Pastori, Daniele, Rivera-Caravaca, Jose Miguel ORCID: 0000-0003-0492-6241, Ding, Wern Yew ORCID: 0000-0003-3596-6545, Gue, Ying Xuan ORCID: 0000-0001-9994-8915, Menichelli, Danilo, Gumprecht, Jakub, Koziel, Monika, Yang, Pil-Sung, Guo, Yutao et al (show 2 more authors) (2022) 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. THROMBOSIS AND HAEMOSTASIS, 122 (03). pp. 406-414.

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Abstract

<h4>Objective</h4>The 'Atrial fibrillation Better Care' (ABC) pathway has been recently proposed as a holistic approach for the comprehensive management of patients with atrial fibrillation (AF). We performed a systematic review of current evidence for the use of the ABC pathway on clinical outcomes.<h4>Methods and results</h4>We performed a systematic review and meta-analysis according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and EMBASE were searched for studies reporting the prevalence of ABC-pathway-adherent management in AF patients, and its impact on clinical outcomes (all-cause death, cardiovascular death, stroke, and major bleeding). Meta-analysis of odds ratio (OR) was performed with random-effects models; subgroup analysis and meta-regression were performed to account for heterogeneity. Among the eight studies included, we found a pooled prevalence of ABC-adherent management of 21% (95% confidence interval, CI: 13-34%), with a high grade of heterogeneity, explained by the increasing adherence to each ABC criterion. Patients treated according to the ABC pathway showed a lower risk of all-cause death (OR: 0.42; 95% CI: 0.31-0.56), cardiovascular death (OR: 0.37; 95% CI: 0.23-0.58), stroke (OR: 0.55; 95% CI: 0.37-0.82) and major bleeding (OR: 0.69; 95% CI: 0.51-0.94), with moderate heterogeneity. Prevalence of comorbidities was moderators of heterogeneity for all-cause and cardiovascular death, while longer follow-up was associated with increased effectiveness for all outcomes.<h4>Conclusion</h4>Adherence to the ABC pathway was suboptimal, being adopted in one in every five patients. Adherence to the ABC pathway was associated with a reduction in the risk of major adverse outcomes.

Item Type: Article
Uncontrolled Keywords: atrial fibrillation, integrated care, ABC pathway, outcomes
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Faculty Management Office
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 13 Mar 2023 09:48
Last Modified: 13 Mar 2023 09:48
DOI: 10.1055/a-1515-9630
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3168959
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