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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: December 11, 2018
Footnotes
Potential Competing Interests: The authors report no competing interests.
Identification
Copyright
© 2018 Mayo Foundation for Medical Education and Research
