Department of Clinical Internal, Anesthesiologic, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, United Kingdom.
Department of Clinical Internal, Anesthesiologic, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Eur J Intern Med. 2021 Mar;85:80-85. doi: 10.1016/j.ejim.2020.12.011. Epub 2021 Jan 6.
An integrated care approach is recommended to optimize management of patients with atrial fibrillation (AF). The impact of the Atrial fibrillation Better Care (ABC) pathway on major adverse cardiac events (MACE), which are the main causes of death in AF, has not been explored.
We investigated the association between ABC compliance and MACE incidence in 1157 (2690 patient-years) nonvalvular AF patients from the ATHERO-AF study. A subgroup analysis by sex and high cardiovascular risk patients as defined by a 2MACE score ≥3 was performed.
Overall, 428 (37%) patients composed the ABC-compliant group. During a median follow up of 23 (IQR 12-37) months, 64 MACE occurred (2.38%/year). Kaplan Meier curve analysis showed a higher rate of MACE in ABC non-compliant group compared to the ABC-compliant (log-rank test p=0.006). The risk of MACE increased by the number of non-fulfilled ABC criteria. On multivariable Cox proportional hazard regression analysis, the ABC non-compliance was associated with an increased risk of MACE (Hazard ratio (HR) 2.244, 95% Confidence Interval (95%CI) 1.129-4.462). Men were more likely to have suboptimal anticoagulation control (group A), while uncontrolled symptoms were more frequent in women. The association between non-ABC and MACE was more evident in men than women (HR 3.647, 95%CI 1.294-10.277) and in patients with 2MACE score ≥3 (HR 1.728, 95%CI 1.209-2.472).
An integrated care ABC approach is associated with a reduced risk of MACE in the AF population, especially in men and in patients at high risk of MACE.
推荐采用综合护理方法来优化心房颤动（AF）患者的管理。尚未探讨心房颤动更好护理（ABC）途径对主要不良心脏事件（MACE）的影响，而 MACE 是 AF 死亡的主要原因。
我们研究了 ATHERO-AF 研究中 1157 例（2690 患者年）非瓣膜性 AF 患者的 ABC 依从性与 MACE 发生率之间的关系。按性别和心血管风险较高（2MACE 评分≥3）的患者进行亚组分析。
总体而言，428 例（37%）患者为 ABC 依从组。中位随访 23（IQR 12-37）个月期间，发生 64 例 MACE（2.38%/年）。Kaplan-Meier 曲线分析显示，ABC 不依从组的 MACE 发生率高于 ABC 依从组（对数秩检验 p=0.006）。不满足 ABC 标准的数量越多，MACE 的风险就越高。多变量 Cox 比例风险回归分析显示，ABC 不依从与 MACE 风险增加相关（危险比（HR）2.244，95%置信区间（95%CI）1.129-4.462）。男性更可能出现抗凝控制不理想（A 组），而女性更常见症状控制不佳。ABC 与 MACE 之间的关联在男性中比女性中更为明显（HR 3.647，95%CI 1.294-10.277），在 2MACE 评分≥3 的患者中更为明显（HR 1.728，95%CI 1.209-2.472）。
综合护理 ABC 方法与 AF 人群中 MACE 风险降低相关，特别是在男性和 MACE 风险较高的患者中。
