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Integrated Care Management of Patients With Atrial Fibrillation and Risk of Cardiovascular Events

The ABC (Atrial fibrillation Better Care) Pathway in the ATHERO-AF Study Cohort
Published:December 11, 2018DOI:https://doi.org/10.1016/j.mayocp.2018.10.022

      Abstract

      Objective

      To investigate the impact on cardiovascular events (CVEs) in a real-world population of patients with atrial fibrillation (AF) by implementing the Atrial fibrillation Better Care (ABC: A, Avoid stroke with anticoagulation; B, better symptom management; C, Cardiovascular and comorbidity risk management) pathway.

      Patients and Methods

      This prospective single-center cohort study included 907 consecutive patients with nonvalvular AF on vitamin K antagonists from February 2008 to December 2016. The A, B, and C groups were defined as follows: “A” by a Time in Therapeutic Range ≥65%; “B” by a European Heart Rhythm Association (EHRA) symptom scale I-II, and “C” as optimized cardiovascular comorbidity management. Primary end point was a composite outcome of CVEs.

      Results

      During a median follow-up of 36.9 months (interquartile range [IQR] 20.0-57.5; 3022 patient-years), 118 CVEs occurred (3.9% per year; 95% confidence interval [CI], 3.2-4.7). Symptomatic patients (EHRA III-IV) had a higher risk of CVEs compared with those in EHRA I (hazard ratio [HR], 2.73, 95% CI, 1.61-4.63, P<.001). Optimally managed patients in the ABC group (n=198) had a lower risk of CVEs (1.8 [95% CI, 0.9-3.0] vs 4.5% [95% CI, 3.7-5.5] per year, P=.001) compared with those presenting with at least 1 suboptimal ABC factor (HR, 0.40, 95% CI, 0.22-0.74, P=.003). This association was evident using multivariate Cox proportional regression analysis (HR, 0.44, 95% CI, 0.24-0.80, P=.007).

      Conclusion

      Integrated care management according to the ABC pathway resulted in a significantly lower rate of CVEs, suggesting a clear benefit of a holistic approach to optimize the management of patients with AF.

      Trial Registration

      clinicaltrials.gov Identifier: NCT01882114

      Abbreviations and Acronyms:

      ABC (atrial fibrillation better care), AF (atrial fibrillation), CVEs (cardiovascular events), EHRA (European Heart Rhythm Association), HF (heart failure), HR (hazard ratio), NOACs (non-VKA oral anticoagulants), OAC (oral anticoagulation), TIA (transient ischemic attack), TiTR (time in therapeutic range), VKA (vitamin K antagonist)
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