TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Daiichi Sankyo Europe GmbH, Zielstattstr. 48, Munich, Germany.
Europace. 2022 Nov 22;24(11):1730-1738. doi: 10.1093/europace/euac082.
The Atrial fibrillation Better Care (ABC) pathway is endorsed by guidelines to improve care of patients with atrial fibrillation (AF). However, whether the benefit of ABC pathway-concordant care is consistent across anticoagulants remains unclear. We assessed the association between ABC-concordant care and outcomes in this post hoc analysis from the ENGAGE AF-TIMI 48 trial, which was reported prior to the initial description of the ABC pathway.
Patients were retrospectively classified as receiving ABC-concordant care based on optimal anticoagulation, adequate rate control, management of co-morbidities and lifestyle measures. Associations between ABC-concordance and outcomes were assessed with adjustment for components of the CHA2DS2-VASc and HAS-BLED scores. Of 20 926 patients, 7915 (37.8%) satisfied criteria of ABC-concordant care, which was associated with significantly lower incidence of stroke or systemic embolic event [stroke/SEE: hazard ratio (HRadj): 0.54; 95% confidence interval (CI): 0.47-0.63], major bleeding (HRadj 0.66; 95% CI: 0.58-0.75), major adverse cardiac events (HRadj 0.53; 95% CI: 0.48-0.58), primary net clinical outcome (composite of stroke/SEE, major bleeding or death; HRadj 0.61; 95% CI: 0.56-0.65), cardiovascular (CV) hospitalization (HRadj 0.78; 95% CI: 0.74-0.83), CV death (HRadj 0.52; 95% CI: 0.46-0.58), and all-cause mortality (HRadj 0.56; 95% CI: 0.51-0.62), P < 0.001 for each. These associations were qualitatively consistent for both edoxaban and warfarin and across patient subgroups.
Atrial fibrillation Better Care pathway-concordant care is associated with reductions across multiple CV endpoints and all-cause mortality, with benefit in edoxaban- and warfarin-treated patients and across patient subgroups. Increasing implementation of ABC-concordant care may improve clinical outcomes of patients with AF irrespective of anticoagulant.
房颤最佳护理（ABC）路径得到指南的认可，旨在改善房颤（AF）患者的护理。然而，ABC 路径一致的护理是否对所有抗凝剂都有效尚不清楚。我们评估了 ENGAGE AF-TIMI 48 试验事后分析中 ABC 一致护理与结局之间的关联，该试验在最初描述 ABC 路径之前报告。
根据最佳抗凝、适当的心率控制、合并症和生活方式措施的管理，回顾性地将患者分类为接受 ABC 一致的护理。使用 CHA2DS2-VASc 和 HAS-BLED 评分的组成部分进行调整，评估 ABC 一致性与结局之间的关联。在 20926 名患者中，有 7915 名（37.8%）符合 ABC 一致护理标准，与中风或全身性栓塞事件发生率显著降低相关[中风/SEE：风险比（HRadj）：0.54；95%置信区间（CI）：0.47-0.63]，大出血（HRadj 0.66；95% CI：0.58-0.75），主要不良心脏事件（HRadj 0.53；95% CI：0.48-0.58），主要净临床结局（中风/SEE、大出血或死亡的复合结局；HRadj 0.61；95% CI：0.56-0.65），心血管（CV）住院（HRadj 0.78；95% CI：0.74-0.83），CV 死亡（HRadj 0.52；95% CI：0.46-0.58），以及全因死亡率（HRadj 0.56；95% CI：0.51-0.62），P < 0.001。在依度沙班和华法林治疗的患者以及亚组患者中，这些关联的定性是一致的。
房颤最佳护理（ABC）路径一致的护理与多个心血管终点和全因死亡率的降低相关，在依度沙班和华法林治疗的患者以及亚组患者中均有获益。增加 ABC 一致护理的实施可能会改善 AF 患者的临床结局，无论使用哪种抗凝剂。
