Adherence to the ‘Atrial Fibrillation Better Care’ Pathway in Patients with Atrial Fibrillation: Impact on Clinical Outcomes—A Systematic Review and Meta-Analysis of 285,000 Patients

Abstract

Aims: The ‘Atrial Fibrillation Better Care’ (ABC) pathway has been recently proposed as a holistic approach for the comprehensive management of patients with Atrial Fibrillation (AF). We performed a systematic review of current evidence for the use of the ABC pathway on clinical outcomes. Methods and Results: We performed a systematic review and meta-analysis according to PRISMA Guidelines. Pubmed and EMBASE were searched for studies reporting the prevalence of ABC pathway adherent management in AF patients, and its impact on clinical outcomes (all-cause death, cardiovascular death, stroke, and major bleeding). Metanalysis of odds ratio (OR) was performed with random-effect models; subgroup analysis and meta-regression were performed to account for heterogeneity. Among the 8 studies included, we found a pooled prevalence of ABC adherent management of 21% (95% confidence intervals (CI), 13-34%), with a high grade of heterogeneity, explained by the increasing adherence to each ABC criterion. Patients treated according to the ABC pathway showed a lower risk of all-cause death (OR:0.42, 95%CI 0.31-0.56), cardiovascular death (OR:0.37, 95%CI 0.23-0.58), stroke (OR:0.55, 95%CI 0.37-0.82) and major bleeding (OR:0.69, 95%CI 0.51-0.94), with moderate heterogeneity. Prevalence of comorbidities were moderators of heterogeneity for all-cause and cardiovascular death, while longer follow-up was associated with increased effectiveness for all outcomes. Conclusion: Adherence to the ABC pathway was suboptimal, being adopted in 1 in every 5 patients. Adherence to the ABC pathway was associated with a reduction in the risk of major adverse outcomes.

Integrated Care of Atrial Fibrillation Using the ABC (Atrial fibrillation Better Care) Pathway Improves Clinical Outcomes in Chinese Population: An Analysis From the Chinese Atrial Fibrillation Registry

“…Previous studies have shown that therapies compliant with the holistic care (ABC compliance group) were associated with a significantly lower all-cause death and the composite outcome consisting of cardiovascular motality, myocardial infarction, ischemic stroke, total hospitalizations and major bleeding, compared with non-ABC compliant group (7)(8)(9)(10)(11)(12). Also, a system review and a meta-analysis have revealed an obvious risk reduction in ABC group despite the variation including population selection, definition of ABC and clinical outcomes among these studies (20,21). Our findings are consistent with the foregoing studies presenting lower hazard of all-cause death and the composite outcome in patients compliant with ABC care in comparsion to those without ABC pathway.…”

“Novel Clinical Concepts in Thrombosis”: Integrated Care for Stroke Management—Easy as ABC

“…In a recent systematic review, AF patients treated according to the ABC pathway showed a lower risk of all-cause death (odds ratio [OR]: 0.42, 95% confidence interval [CI]: 0.31-0.56), cardiovascular death (OR: 0.37, 95% CI: 0.23-0.58), stroke (OR: 0.55, 95% CI: 0.37-0.82), and major bleeding (OR: 0.69, 95% CI: 0.51-0.94). 3 Improved clinical outcomes with ABC pathway compliance are evident, even in clinically complex patients such as those with multimorbidity, polypharmacy, and hospitalizations. 4 The mAFA-II trial was a prospective cluster-randomized trial of patients randomized to receive usual care, or integrated care based on the ABC pathway.…”

Real-world applicability and impact of early rhythm control for European patients with atrial fibrillation: a report from the ESC-EHRA EORP-AF Long-Term General Registry

“…The use of rate and rhythm control to reduce the burden of symptoms is one of the pillars of the ABC pathway [1]. Such a structured approach to holistic AF care, including proactive risk evaluation and management, has been shown to be associated with improved clinical outcomes, especially with a reduction in hospitalizations and clinical events [19,[32][33][34].…”