Roldán Vanessa, Martínez-Montesinos Lorena, López-Gálvez Raquel, García-Tomás Lucía, Lip Gregory Y H, Rivera-Caravaca José Miguel, Marín Francisco
Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), 30008 Murcia, Spain.
Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, 30120 Murcia, Spain.
J Pers Med. 2022 Mar 17;12(3):487. doi: 10.3390/jpm12030487.
The Atrial Fibrillation Better Care (ABC) pathway was proposed for a more integrated atrial fibrillation (AF) care. We investigated if adherence to the ABC pathway was associated to the quality of anticoagulation control in a cohort of AF outpatients starting vitamin K antagonists (VKAs) between July 2016 and June 2018. Patients were considered adherent to the ABC pathway if they met all of its components. The time in therapeutic range (TTR) was estimated at one year. In total, 1045 patients (51.6% female; median age 77 years; 63% ABC pathway adherent) were included. At one year, 474 (51.6%) of 919 patients with international normalized ratio (INR) data for TTR estimation had a TTR < 65%. Among ABC pathway non-adherent patients, a greater proportion had TRT < 65% (56.4% vs. 43.6%, p = 0.025), and TTR < 70% (64.9% vs. 35.1%, p = 0.033), with lower mean TTR in non-adherent patients (59.4 ± 22.3% vs. 63.9 ± 21.1%; p = 0.004). Logistic regression models demonstrated that the ABC pathway adherence in its continuous (aOR: 0.75, 95% CI 0.59−0.96) and categorical (aOR: 0.75, 95% CI 0.57−0.98) forms was independently associated with TTR ≥ 65%. In this ‘real-world’ cohort of AF patients starting VKAs, the ABC pathway adherent patients had better TTR, and more ABC criteria fulfilled increased the probability of achieving good TTR.
心房颤动优化治疗（ABC）路径旨在实现更综合的心房颤动（AF）护理。我们调查了在2016年7月至2018年6月期间开始使用维生素K拮抗剂（VKA）的AF门诊患者队列中，遵循ABC路径是否与抗凝控制质量相关。如果患者符合ABC路径的所有组成部分，则被视为遵循该路径。治疗范围内时间（TTR）在一年时进行估算。总共纳入了1045例患者（女性占51.6%；中位年龄77岁；63%遵循ABC路径）。一年时，在919例有国际标准化比值（INR）数据用于TTR估算的患者中，474例（51.6%）的TTR<65%。在未遵循ABC路径的患者中，更大比例的患者TRT<65%（56.4%对43.6%，p = 0.025），且TTR<70%（64.9%对35.1%，p = 0.033），未遵循路径的患者平均TTR较低（59.4±22.3%对63.9±21.1%；p = 0.004）。逻辑回归模型表明，ABC路径的连续形式（调整后比值比：0.75，95%置信区间0.59 - 0.96）和分类形式（调整后比值比：0.75，95%置信区间0.57 - 0.98）均与TTR≥65%独立相关。在这个开始使用VKA的AF患者“真实世界”队列中，遵循ABC路径的患者TTR更佳，满足更多ABC标准增加了实现良好TTR的概率。
