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

Bucci, Tommaso ORCID: 0000-0003-2895-6234, Proietti, Marco ORCID: 0000-0003-1452-2478, Shantsila, Alena ORCID: 0000-0002-0594-8576, Romiti, Giulio Francesco, Teo, Wee-Siong, Park, Hyung-Wook, Shimizu, Wataru, Tse, Hung-Fat, Lip, Gregory YH ORCID: 0000-0002-7566-1626 and Chao, Tze-Fan (2023) Integrated Care for Atrial Fibrillation Using the ABC Pathway in the Prospective APHRS-AF Registry. JACC: Asia, 3 (4). pp. 580-591.

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Official URL: http://dx.doi.org/10.1016/j.jacasi.2023.04.008

Abstract

<h4>Background</h4>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 symptoms control; "C" Cardiovascular risk-factor and comorbidities management.<h4>Objectives</h4>This study sought to investigate the association with outcomes of ABC adherence in the prospective multinational Asia-Pacific Heart Rhythm Society (APHRS) Atrial Fibrillation registry.<h4>Method</h4>Cox-regression analyses adjusted for age, sex, CHA<sub>2</sub>DS<sub>2</sub>-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.<h4>Results</h4>Of 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%, <i>P</i> < 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 (<i>P</i><sub>int</sub> = 0.217).<h4>Conclusions</h4>In 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).

Item Type:	Article
Uncontrolled Keywords:	APHRS-AF Registry Investigators
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	23 Aug 2023 10:03
Last Modified:	30 Aug 2023 15:10
DOI:	10.1016/j.jacasi.2023.04.008
Open Access URL:	https://doi.org/10.1016/j.jacasi.2023.04.008
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3172306