Adherence to the recently proposed “Atrial Fibrillation Better Care” (ABC) pathway, a holistic comprehensive treatment approach for patients with atrial fibrillation (AF), has been associated with a reduction in risk of serious adverse outcomes, but the pathway was only adopted by 1 in 5 patients, according to a systematic review published in Thrombosis and Haemostasis.
The ABC path is based on the following pillars: avoiding a stroke (through the use of anticoagulants), better symptom management, and cardiovascular and comorbidity management. This approach is currently recommended in a number of clinical guidelines, including those for AF management by the European Society of Cardiology (ESC).
Researchers performed a meta-analysis and a systematic review according to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). Studies reporting ABC path management compliance and the impact on clinical outcomes in patients with AF were found by searching EMBASE and PubMed. Key endpoints included stroke, major bleeding, cardiovascular death, and total death. Random effects models were used to perform a meta-analysis of odds ratio (OR) and meta-regression, and subgroup analyzes were performed to account for heterogeneity.
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Among the 7 observational studies included, the pooled prevalence of ABC adherence was 21% (95% CI, 13% -34%), with a high degree of heterogeneity due to increasing compliance with each ABC criterion. Patients who adhered to ABC path management showed a significantly lower risk of 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 and a significantly lower risk of cardiovascular death (OR 0.37; 95% CI 0.23-0.58) and total death (OR 0.42; 95% CI 0 , 31-0.56) with a high degree of heterogeneity.
A direct association was found between longer follow-up periods and increased efficacy for all endpoints, while an increasing prevalence of congestive heart failure, diabetes mellitus, coronary artery disease and stroke was associated with the decreased effectiveness of the ABC pathway for all causes and cardiovascular disease Death, which accounts for the heterogeneity in these results. The sensitivity analysis did not reveal any significant differences between the studies.
Although this systematic review and meta-analysis has some limitations, including the retrospective and observational nature of most of the included studies and the fact that 2 of the included studies were conducted more than 10 years ago, the authors concluded that it was on the ABC path was used suboptimally and was used in [1] in each [5 patients with] FROM.”
The authors of the systematic review added: “Compliance with the ABC path was associated with a significant reduction in risk [for] serious adverse outcomes with a significantly reduced risk [for] Death from all causes, death from cardiovascular diseases, stroke and severe bleeding. “
Disclosure: A study author stated links with biotech, pharmaceutical, and / or device companies. For a full list of specifications, see the original reference.
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Romiti GF, Pastori D, Rivera-Caravaca JM, et al. 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. Thromb hemost. Published online May 21, 2021. doi: 10.1055 / a-1515-9630
This article originally appeared on The Cardiology Advisor
