Application of the simple atrial fibrillation better care pathway for integrated care management in frail patients with atrial fibrillation: A nationwide cohort study

Background An integrated care approach might be of benefit for clinical outcomes of patients with atrial fibrillation (AF). This study evaluated whether compliance with the Atrial fibrillation Better Care (ABC) pathway for integrated care management (“A” Avoid stroke; “B” Better symptom management; “C” Cardiovascular risk and Comorbidity optimization) would improve population-based clinical outcomes in a nationwide AF cohort. Methods and Results From the Korea National Health Insurance Service database, a total of 204,842 nonvalvular AF patients were enrolled between January 1, 2005 and December 31, 2015. Patients that fulfilled all criteria of the ABC pathway were defined as the “ABC” group, and those who did not were the “Non-ABC” group.Over a mean follow-up of 6.2 ± 3.5 years, the ABC pathway compliant group had lower rates of all-cause death (0.80 vs. 2.72 per 100 person-years, p < 0.001) and the composite outcome of “death, ischemic stroke, major bleeding, and myocardial infarction” (2.34 vs. 5.92 per 100 person-years, p < 0.001) compared with the Non-ABC compliant group. Adjusted Cox multivariable regression showed that the ABC group had a significantly lower risk of all-cause death (adjusted hazard ratio [HR] 0.82; 95% confidence interval [CI], 0.78–0.86) and the composite outcome (adjusted HR 0.86; 95% CI, 0.83–0.89). With the increasing numbers of ABC pathway criteria fulfilled, the risk of all-cause death and composite outcome were progressively lowered. Conclusion In the first study of a nationwide population cohort, we show that compliance with the simple ABC pathway is associated with improved clinically relevant outcomes of patients with AF. Given the high health care burden associated with AF, such a streamlined holistic approach to AF management should be implemented, to improve the care of such patients.

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Improved Outcomes by Integrated Care of Anticoagulated Patients with Atrial Fibrillation Using the Simple ABC (Atrial Fibrillation Better Care) Pathway

The American Journal of Medicine ◽

10.1016/j.amjmed.2018.06.012 ◽

2018 ◽

Vol 131 (11) ◽

pp. 1359-1366.e6 ◽

Cited By ~ 47

Author(s):

Marco Proietti ◽

Giulio Francesco Romiti ◽

Brian Olshansky ◽

Deirdre A. Lane ◽

Gregory Y.H. Lip

Keyword(s):

Atrial Fibrillation ◽

Integrated Care ◽

Care Pathway ◽

Improved Outcomes ◽

Anticoagulated Patients

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Mobile health technology facilitates population screening and integrated care management in patients with atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehaa161 ◽

2020 ◽

Vol 41 (17) ◽

pp. 1617-1619

Author(s):

Yutao Guo ◽

Deirdre A Lane ◽

Yundai Chen ◽

Gregory Y H Lip

Keyword(s):

Atrial Fibrillation ◽

Integrated Care ◽

Mobile Health ◽

Care Management ◽

Health Technology ◽

Population Screening ◽

Mobile Health Technology

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The effectiveness of an integrated care pathway in geriatric rehabilitation among older patients with complex health problems and their informal caregivers: a prospective cohort study

BMC Geriatrics ◽

10.1186/s12877-018-0971-4 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 8

Author(s):

Irma H. J. Everink ◽

Jolanda C. M. van Haastregt ◽

Frans E. S. Tan ◽

Jos M. G. A. Schols ◽

Gertrudis I. J. M. Kempen

Keyword(s):

Cohort Study ◽

Integrated Care ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Older Patients ◽

Care Pathway ◽

Health Problems ◽

Geriatric Rehabilitation ◽

Integrated Care Pathway ◽

Complex Health Problems

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Relation of outcomes to ABC (Atrial Fibrillation Better Care) pathway adherent care in European patients with atrial fibrillation: an analysis from the ESC-EHRA EORP Atrial Fibrillation General Long-Term (AFGen LT) Registry

EP Europace ◽

10.1093/europace/euaa274 ◽

2020 ◽

Cited By ~ 1

Author(s):

Marco Proietti ◽

Gregory Y H Lip ◽

Cécile Laroche ◽

Laurent Fauchier ◽

Francisco Marin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Integrated Care ◽

Lower Risk ◽

Care Pathway ◽

Real Life ◽

Research Programme ◽

Coronary Syndrome ◽

The Impact

Abstract Aims There has been an increasing focus on integrated, multidisciplinary, and holistic care in the treatment of atrial fibrillation (AF). The ‘Atrial Fibrillation Better Care’ (ABC) pathway has been proposed to streamline integrated care in AF. We evaluated the impact on outcomes of an ABC adherent management in a contemporary real-life European-wide AF cohort. Methods and results Patients enrolled in the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry with baseline data to evaluate ABC criteria and available follow-up data were considered for this analysis. Among the original 11 096 AF patients enrolled, 6646 (59.9%) were included in this analysis, of which 1996 (30.0%) managed as ABC adherent. Patients adherent to ABC care had lower CHA2DS2-VASc and HAS-BLED scores (mean ± SD, 2.68 ± 1.57 vs. 3.07 ± 1.90 and 1.26 ± 0.93 vs. 1.58 ± 1.12, respectively; P < 0.001). At 1-year follow-up, patients managed adherent to ABC pathway compared to non-adherent ones had a lower rate of any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death (3.8% vs. 7.6%), CV death (1.9% vs. 4.8%), and all-cause death (3.0% vs. 6.4%) (all P < 0.0001). On Cox multivariable regression analysis, ABC adherent care showed an association with a lower risk of any TE/ACS/CV death [hazard ratio (HR): 0.59, 95% confidence interval (CI): 0.44–0.79], CV death (HR: 0.52, 95% CI: 0.35–0.78), and all-cause death (HR: 0.57, 95% CI: 0.43–0.78). Conclusion In a large contemporary cohort of European AF patients, a clinical management adherent to ABC pathway for integrated care is associated with a significant lower risk for cardiovascular events, CV death, and all-cause death.

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The Effect of Integrated Care Management on Dementia in Atrial Fibrillation

Journal of Clinical Medicine ◽

10.3390/jcm9061696 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1696 ◽

Cited By ~ 1

Author(s):

Pil-Sung Yang ◽

Jung-Hoon Sung ◽

Eunsun Jang ◽

Hee Tae Yu ◽

Tae-Hoon Kim ◽

...

Keyword(s):

Atrial Fibrillation ◽

Health Insurance ◽

Integrated Care ◽

Care Management ◽

Stroke Risk ◽

Care Approach ◽

Medical Burden ◽

Stratified Analysis ◽

Reduced Risk

Clinical outcomes of patients with atrial fibrillation (AF) can be improved by an integrated care approach. We analyzed whether adherence with the AF Better Care (ABC) pathway for integrated care management would reduce the risk of dementia in a nationwide AF cohort. Using the National Health Insurance Service database of Korea, 228,026 non-valvular AF patients were retrospectively evaluated between 2005 and 2015. Patients meeting all criteria of the ABC pathway were classified as the “ABC” group and those not classified as the “non-ABC” group. During a median (25th, 75th percentiles) follow-up of 6.0 (3.3, 9.5) years, the ABC group had lower rates and risk of overall dementia (0.17 vs. 1.11 per 100 person-years, p < 0.001; hazard ratio (HR) 0.80; 95% CI 0.73–0.87) and both Alzheimer’s (HR 0.79, 95% CI 0.71–0.88) and vascular dementia (HR 0.76, 95% CI 0.59–0.98) than the non-ABC group. The stratified analysis showed that the ABC pathway reduced the risk of dementia regardless of sex, comorbidities, and in patients with high stroke risk. Adherence with the ABC pathway is associated with a reduced risk of dementia in AF patients. Due to the high medical burden of AF, it is necessary to implement integrated AF management to reduce the risk of dementia.

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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

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.762245 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yu-Feng Wang ◽

Chao Jiang ◽

Liu He ◽

Xin Du ◽

Cai-Hua Sang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Integrated Care ◽

Intracranial Hemorrhage ◽

Care Pathway ◽

Symptom Control ◽

Multivariable Analysis ◽

Management Approach ◽

Composite Outcome ◽

Incident Rate

Background: “Atrial fibrillation Better Care” (ABC) pathway has been proposed to improve the management of patients suffered from atrial fibrillation (AF). This integrated or holistic management approach comprise of three aspects, including “A” Avoid stroke or Anticoagulation; “B” Better symptom control with rate or rhythm control strategies; “C” Cardiovascular risk factor and Concomitant diseases management. We aimed to confirm the beneficial evidence of ABC pathway compliance in a Chinese AF cohort.Method and Results: From the Chinese Atrial Fibrillation registry (CAFR) dataset, a total of 19,187 non-valvular AF patients were enrolled, of which 4.365 (22.8%) were ABC pathway compliant (ABC compliance group). During a median follow-up of 4.1 ± 1.8 years, The incident rate of all-cause death in ABC compliance group and non-ABC compliance group is 2.7 and 1.1 per 100 person-year (p < 0.001), the incident rate of ischemic stroke is 1.3 and 0.8% per 100 person-year (p < 0.001), the incident rate of composite outcome, which consist of all-cause death, ischemic stroke and intracranial hemorrhage, is 3.8 and 1.9 per 100 person-year (p < 0.001). On Cox multivariable analysis, ABC pathway shows an independently association with reduction of all-cause death [hazard ratio (HR) = 0.82; 95% confidence interval (CI) = 0.70–0.95] and the composite outcome (HR 0.86, 95% CI 0.76–0.96). The increasingly components of ABC integrated care compliance is associated with lower risk of all-cause death and composite events.Conclusion: In a large cohort of Chinese AF patients, ABC pathway compliance shows an independently association with reduction of all-cause death and composite outcome of all-cause death, ischemic stroke and intracranial hemorrhage. Better compliance of ABC integrated care contributes to lower HR for adverse events.

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