Improved Outcomes by Integrated Care of Anticoagulated Patients with Atrial Fibrillation Using the Simple ABC (Atrial Fibrillation Better Care) Pathway

Marco Proietti, Giulio Francesco Romiti, Brian Olshansky, Deirdre A Lane, Gregory Y H Lip
American Journal of Medicine 2018, 131 (11): 1359-1366.e6

BACKGROUND: Integrated care for the clinical management of atrial fibrillation patients is advocated as a holistic way to improve outcomes; the simple Atrial fibrillation Better Care (ABC) pathway has been proposed. The ABC pathway streamlines care as follows: 'A' Avoid stroke; 'B' Better symptom management; 'C' Cardiovascular and Comorbidity optimization.

METHODS: We performed a post hoc analysis of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) trial. An 'integrated care' approach was defined according to the ABC pathway. Patients fulfilling all criteria were categorized as the 'ABC' group; those not fulfilling all criteria were the 'non-ABC' group. Trial-adjudicated all-cause death, composite outcome of stroke/major bleeding/cardiovascular death, and first hospitalization were the main study outcomes.

RESULTS: Among the 4060 patients in the original cohort, 3169 (78%) had available data to compare integrated care (ABC; n = 222; 7%) vs non-ABC (n = 2947; 93%) management. Over a median follow-up of 3.7 (interquartile range, 2.8-4.6) years, atrial fibrillation patients managed with integrated care (ABC group) had lower rates for all study outcomes (all P < .001) compared with the non-ABC group. A Cox multivariable regression analysis showed that atrial fibrillation patients managed in the ABC group had a significantly lower risk of all-cause death (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.17-0.75), composite outcome (HR, 0.35; 95% CI, 0.18-0.68), and first hospitalization (HR, 0.65; 95% CI, 0.53-0.80).

CONCLUSIONS: The simple ABC pathway allows the streamlining of integrated care for atrial fibrillation patients in a holistic manner and is associated with a lower risk of adverse outcomes (including mortality, stroke/major bleeding/cardiovascular death, and hospitalization).

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