Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy.
Eur J Intern Med. 2022 Nov;105:54-62. doi: 10.1016/j.ejim.2022.08.004. Epub 2022 Aug 23.
Implementation of the Atrial fibrillation Better Care (ABC) pathway is recommended by guidelines on atrial fibrillation (AF), but the impact of adherence to ABC pathway in patients with cancer is unknown.
To investigate the adherence to ABC pathway and its impact on adverse outcomes in AF patients with cancer.
Patients enrolled in the EORP-AF General Long-Term Registry were analyzed according to (i) No Cancer; and (ii) Prior or active cancer and stratified in relation to adherence to the ABC pathway. The composite Net Clinical Outcome (NCO) of all-cause death, major adverse cardiovascular events and major bleeding was the primary endpoint.
Among 6550 patients (median age 69 years, females 40.1%), 6005 (91.7%) had no cancer, while 545 (8.3%) had a diagnosis of active or prior cancer at baseline, with the proportions of full adherence to ABC pathway of 30.6% and 25.7%, respectively. Adherence to the ABC pathway was associated with a significantly lower occurrence of the primary outcome vs. non-adherence, both in 'no cancer' and 'cancer' patients [adjusted Hazard Ratio (aHR) 0.78, 95% confidence interval (CI): 0.66-0.92 and aHR 0.59, 95% CI 0.37-0.96, respectively]. Adherence to a higher number of ABC criteria was associated with a lower risk of the primary outcome, being lowest when 3 ABC criteria were fulfilled (no cancer: aHR 0.54, 95%CI: 0.36-0.81; with cancer: aHR 0.32, 95% CI 0.13-0.78).
In AF patients with cancer enrolled in the EORP-AF General Long-Term Registry, adherence to ABC pathway was sub-optimal. Full adherence to ABC-pathway was associated with a lower risk of adverse events.
心房颤动（AF）指南推荐实施心房颤动更好的护理（ABC）路径，但癌症患者遵循 ABC 路径的影响尚不清楚。
研究癌症合并 AF 患者遵循 ABC 路径的情况及其对不良结局的影响。
根据（i）无癌症和（ii）有或曾有癌症，对 EORP-AF 一般长期注册研究中的患者进行分析，并按 ABC 路径的遵循情况进行分层。全因死亡、主要心血管不良事件和主要出血的复合净临床结局（NCO）是主要终点。
在 6550 例患者（中位年龄 69 岁，女性占 40.1%）中，6005 例（91.7%）无癌症，545 例（8.3%）基线时有活动性或既往癌症诊断，完全遵循 ABC 路径的比例分别为 30.6%和 25.7%。与不遵循 ABC 路径相比，遵循 ABC 路径与主要结局的发生率显著降低，在“无癌症”和“癌症”患者中均如此[校正后的危险比（aHR）分别为 0.78（95%置信区间[CI]：0.66-0.92）和 0.59（95%CI：0.37-0.96）]。遵循更多的 ABC 标准与主要结局风险降低相关，当满足 3 项 ABC 标准时风险最低（无癌症：aHR 0.54（95%CI：0.36-0.81）；有癌症：aHR 0.32（95%CI：0.13-0.78）]。
在 EORP-AF 一般长期注册研究中纳入的癌症合并 AF 患者中，ABC 路径的遵循情况并不理想。完全遵循 ABC 路径与不良事件风险降低相关。
