Miguel Rivera-Caravaca, Jose, Roldan, Vanessa, Martinez-Montesinos, Lorena, Vicente, Vicente, Lip, Gregory YH 
ORCID: 0000-0002-7566-1626 and Marin, Francisco
(2023)
The Atrial Fibrillation Better Care (ABC) Pathway and Clinical Outcomes in Patients with Atrial Fibrillation: the Prospective Murcia AF Project Phase II Cohort.
JOURNAL OF GENERAL INTERNAL MEDICINE, 38 (2).
pp. 315-323.
|
PDF
The Atrial Fibrillation Better Care (ABC) Pathway and Clinical Outcomes in Patients with Atrial Fibrillation the Prospective.pdf - Open Access published version Download (619kB) | Preview |
Abstract
<h4>Background</h4>The Atrial fibrillation Better Care (ABC) pathway was proposed for a more holistic or integrated care approach to atrial fibrillation (AF) management. We investigated whether adherence with the ABC pathway reduced the risk of adverse clinical outcomes in real-world AF patients starting vitamin K antagonist (VKAs) therapy.<h4>Methods</h4>Prospective cohort study including AF outpatients starting VKA therapy from July 2016 to June 2018. Patients were considered as adherent if all ABC pathway criteria (A: Avoid stroke; B: Better symptom control; and C: Cardiovascular risk factors/comorbidities management) were fulfilled. The primary endpoints were all-cause mortality, net clinical outcomes (NCOs), major adverse cardiovascular events (MACE), and composite thrombotic/thromboembolic events at 2 years.<h4>Results</h4>We enrolled 1045 patients (51.6% female; median age 77 [70-83] years). Of these, 63.0% (658) were adherent to the ABC pathway and 37% (387) were considered non-adherent. Compared to non-adherent patients, those who were ABC adherent had lower event rates for all-cause mortality (13.76 vs. 6.56; p<0.001), NCOs (19.65 vs. 11.94; p<0.001), and MACE (11.88 vs. 7.75; p=0.006) during the follow-up. Adjusted Cox regression analyses demonstrated that the ABC pathway adherent care reduced the risks of all-cause mortality (aHR 0.57, 95% CI 0.42-0.78), NCOs (aHR 0.72, 95% CI 0.56-0.92), and cardiovascular mortality (aHR 0.54, 95% CI 0.32-0.90). Event-free survivals for all-cause mortality, NCOs (both log-rank p-values <0.001), and MACE (log-rank p-value = 0.004) were also higher in ABC pathway adherent patients.<h4>Conclusions</h4>In this real-world prospective cohort of AF patients starting VKA therapy, adherence to the ABC pathway management at baseline significantly reduced the risk of NCOs, all-cause mortality, and cardiovascular death at 2 years.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Atrial fibrillation, ABC pathway, Integrated care, Mortality, MACE |
| 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: | 10 Oct 2023 15:56 |
| Last Modified: | 23 Nov 2023 19:49 |
| DOI: | 10.1007/s11606-022-07567-5 |
| Open Access URL: | https://doi.org/10.1007/s11606-022-07567-5 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3173594 |
Dimensions
Dimensions
