房颤患者 ABC（房颤更好护理）路径的临床复杂性和影响：来自 ESC-EHRA EURObservational Research Programme in AF 一般长期注册研究的报告。
Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry.
机构信息
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 West Derby St, Liverpool, L7 8TX, UK.
Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
出版信息
BMC Med. 2022 Sep 2;20(1):326. doi: 10.1186/s12916-022-02526-7.
BACKGROUND
Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The 'Atrial fibrillation Better Care' (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients.
METHODS
From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses.
RESULTS
Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58-0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52-0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58-0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56-0.98) and composite outcome (aHR: 0.76, 95%CI 0.60-0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome.
CONCLUSIONS
An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients.
背景
心房颤动（AF）患者的临床复杂性日益普遍。“AF 更好的护理（ABC）”途径方法旨在简化更全面和综合的 AF 护理方法；然而，关于其在临床复杂患者中的有用性的数据有限。我们旨在确定 ABC 途径在当代临床复杂 AF 患者队列中的影响。
方法
从 ESC-EHRA EORP-AF 一般长期注册中心，我们分析了临床复杂的 AF 患者，定义为存在虚弱、多种合并症和/或多药治疗。进行了 K-均值聚类分析以确定不同的临床复杂性组。通过 Cox 回归分析和事件延迟（DoE）分析来分析 ABC 方法的依从性对主要结局的影响。
结果
在纳入的 9966 例 AF 患者中，8289 例（83.1%）为临床复杂。在临床复杂组中，遵循 ABC 途径降低了全因死亡的风险（调整后的 HR[aHR]：0.72，95%CI 0.58-0.91）、主要不良心血管事件（MACEs；aHR：0.68，95%CI 0.52-0.87）和复合结局（aHR：0.70，95%CI：0.58-0.85）。遵循 ABC 途径与死亡风险（aHR：0.74，95%CI 0.56-0.98）和复合结局（aHR：0.76，95%CI 0.60-0.96）显著降低相关，在高复杂性组中也观察到 MACEs 的类似趋势。在 DoE 分析中，在临床复杂患者中，遵循 ABC 方法可显著提高所有研究结局的无事件生存。根据 1 年随访时的绝对风险降低，ABC 途径依从性的治疗人数分别为全因死亡 24 人、MACEs 31 人和复合结局 20 人。
结论
遵循 ABC 方法可降低临床复杂 AF 患者的主要结局风险。确保遵循 ABC 途径对于改善临床复杂 AF 患者的临床结局至关重要。
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