The Atrial Fibrillation Better Care pathway for managing atrial fibrillation: a review

Abstract

The 2020 European Society of Cardiology guidelines endorse the Atrial Fibrillation Better Care (ABC) pathway as a structured approach for the management of atrial fibrillation (AF), addressing three principal elements: ‘A’ – avoid stroke (with oral anticoagulation), ‘B’ – patient-focused better symptom management, and ‘C’ – cardiovascular and comorbidity risk factor reduction and management. This review summarizes the definitions used for the ABC criteria in different studies and the impact of adherence/non-adherence on clinical outcomes, from 12 studies on seven different cohorts. All studies consistently showed statistically significant reductions in the risk of stroke, myocardial infarction, and mortality among those with ABC pathway adherent treatment. The ABC pathway provides a simple decision-making framework to enable consistent equitable care from clinicians in primary and secondary/tertiary care. Further research examining the impact of ABC pathway implementation in prospective cohorts utilizing consistent inclusion criteria and definitions of ‘A’, ‘B’, and ‘C’ adherent care is warranted.

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 – 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.…”

Optimizing adherence and persistence to non-vitamin K antagonist oral anticoagulant therapy in atrial fibrillation

“… 51 It leads to improved treatment adherence, reduced perceived treatment burden and better outcomes. 51 , 114 , 115 …”

“…The practice of integrated care therefore involves a multidisciplinary team and a close collaboration between different healthcare services across primary, secondary, and tertiary care settings. 51 , 114 , 115 …”

“…111 Another recent review also highlighted the possible reduction in the risk of myocardial infarction and hospitalizations. 115 …”

“… 4 , 117 Although this comprehensive treatment approach for AF patients has been associated with a better prognosis, clinical management adherent to the ABC pathway remains suboptimal, around 21%, meaning that more efforts are needed to follow this strategy. 111 , 115 …”