Affiliation:
1. Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool United Kingdom
2. Department of Clinical Sciences and Community Health University of Milan Italy
3. Geriatric Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
4. Department of Internal Medicine and Medical Specialties Sapienza‐University of Rome Italy
5. Division of Cardiovascular Medicine University of Iowa Hospitals and Clinics Iowa City IA
6. Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark
Abstract
Background
For patients with atrial fibrillation, a comprehensive care approach based on the Atrial fibrillation Better Care (
ABC
) pathway can reduce the occurrence of adverse outcomes. The aim of this paper was to investigate if an approach based on the
ABC
pathway is associated with a reduced risk of adverse events in “clinically complex” atrial fibrillation patients, including those with multiple comorbidities, polypharmacy, and prior hospitalizations.
Methods and Results
We performed a post hoc analysis of the AFFIRM (Atrial Fibrillation Follow‐up Investigation of Rhythm Management) trial. The principal outcome was the composite of all‐cause hospitalization and all‐cause death. An integrated care approach (
ABC
group) was used in 3.8% of the multimorbidity group, 4.0% of the polypharmacy group, and 4.8%, of the hospitalized groups. In all “clinically complex” groups, the cumulative risk of the composite outcome was significantly lower in patients managed consistent with the
ABC
pathway versus non‐
ABC
pathway‐adherent (all
P
<0.05). Cox regression analysis showed a reduction of composite outcomes in
ABC
pathway‐adherent versus non‐
ABC
pathway‐adherent for multimorbidity (hazard ratio [
HR
], 0.61, 95% CI, 0.44–0.85), polypharmacy (
HR
, 0.68, 95%
CI
, 0.47–1.00), and hospitalization (
HR
, 0.59, 95%
CI
, 0.42–0.85) groups. Secondary analyses showed that the higher number of
ABC
criteria fulfilled the larger associated reduction in relative risk, even for secondary outcomes considered.
Conclusions
Use of an
ABC
consistent pathway is associated with fewer major adverse events in patients with atrial fibrillation who have multiple comorbidities, use of polypharmacy, and prior hospitalization.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
80 articles.
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