Background 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. Objectives 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. Method Cox-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. Results 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%, 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). Conclusions 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)

Integrated Care for Atrial Fibrillation Using the ABC Pathway in the Prospective APHRS-AF Registry / Bucci, Tommaso; Proietti, Marco; Shantsila, Alena; Romiti, Giulio Francesco; Teo, Wee-Siong; Park, Hyung-Wook; Shimizu, Wataru; Tse, Hung-Fat; Lip, Gregory Y. H.; Chao, Tze-Fan. - In: JACC. ASIA. - ISSN 2772-3747. - (2023). [10.1016/j.jacasi.2023.04.008]

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

Bucci, Tommaso;Romiti, Giulio Francesco;
2023

Abstract

Background 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. Objectives 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. Method Cox-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. Results 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%, 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). Conclusions 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)
2023
atrial fibrillation integrated care quality indicators
01 Pubblicazione su rivista::01a Articolo in rivista
Integrated Care for Atrial Fibrillation Using the ABC Pathway in the Prospective APHRS-AF Registry / Bucci, Tommaso; Proietti, Marco; Shantsila, Alena; Romiti, Giulio Francesco; Teo, Wee-Siong; Park, Hyung-Wook; Shimizu, Wataru; Tse, Hung-Fat; Lip, Gregory Y. H.; Chao, Tze-Fan. - In: JACC. ASIA. - ISSN 2772-3747. - (2023). [10.1016/j.jacasi.2023.04.008]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1684391
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