房颤患者遵循房颤更佳治疗（ABC）路径与主要结局风险：来自前瞻性GLORIA-AF注册研究的事后分析
Adherence to the Atrial Fibrillation Better Care (ABC) pathway and the risk of major outcomes in patients with atrial fibrillation: A post-hoc analysis from the prospective GLORIA-AF Registry.
作者信息
Romiti Giulio Francesco, Proietti Marco, Bonini Niccolò, Ding Wern Yew, Boriani Giuseppe, Huisman Menno V, Lip Gregory Y H
机构信息
Liverpool Centre for Cardiovascular Science, at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy.
出版信息
EClinicalMedicine. 2022 Nov 24;55:101757. doi: 10.1016/j.eclinm.2022.101757. eCollection 2023 Jan.
BACKGROUND
The 'Atrial fibrillation Better Care' (ABC) pathway has been proposed to streamline a more holistic or integrated care approach to atrial fibrillation (AF) management. We aimed to analyse the impact of adherence to the ABC pathway on the risk of major adverse outcomes in a contemporary prospective global cohort of patients with AF.
METHODS
Patients enrolled Phase II and III of the GLORIA-AF Registry with complete data on ABC pathway adherence and follow-up were included in this post-hoc analysis between November 2011 and December 2014 for Phase II, and between January 2014 and December 2016 for Phase III. The primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACEs). Multivariable Cox-regression and delay of event (DoE) analyses were used to evaluate the association between adherence to the ABC pathway and the risk of outcomes.
FINDINGS
We included 24,608 patients in this analysis (mean age: 70.2 (10.3) years, 10,938 (44.4%) females). Adherence to the ABC pathway was associated with a significant risk reduction for the primary outcome, with greatest magnitude observed for full ABC pathway adherence (adjusted Hazard Ratio [aHR] 0.54, 95% Confidence Interval [CI]: 0.44-0.67, p < 0.0001). ABC pathway adherence was also associated with reduced risk of mortality (aHR: 0.89, 95% CI: 0.79-1.00, p = 0.048), thromboembolism (aHR: 0.78, 95% CI: 0.65-0.94, p = 0.0078), and MACE (aHR: 0.82, 95% CI: 0.71-0.95, p = 0.0071). An increasing number of ABC criteria attained was associated with longer event-free survival in the DoE analysis.
INTERPRETATION
Adherence to the ABC pathway in patients with AF was associated with a reduced risk of major adverse events, including mortality, thromboembolism and MACE. This underlines the importance of using the ABC pathway in the clinical care of patients with AF.
FUNDING
This study was funded by Boehringer Ingelheim.
背景
“房颤优化治疗”（ABC）路径旨在简化房颤（AF）管理中更全面或综合的治疗方法。我们旨在分析在当代全球前瞻性房颤患者队列中，遵循ABC路径对主要不良结局风险的影响。
方法
2011年11月至2014年12月纳入GLORIA-AF注册研究II期且有ABC路径依从性完整数据及随访资料的患者，以及2014年1月至2016年12月纳入III期的患者，进行此次事后分析。主要结局是全因死亡和主要不良心血管事件（MACE）的复合结局。采用多变量Cox回归和事件延迟（DoE）分析来评估遵循ABC路径与结局风险之间的关联。
结果
本分析纳入24,608例患者（平均年龄：70.2（10.3）岁，10,938例（44.4%）为女性）。遵循ABC路径与主要结局的风险显著降低相关，在完全遵循ABC路径时观察到的降幅最大（调整后风险比[aHR]0.54，95%置信区间[CI]：0.44 - 0.67，p < 0.0001）。ABC路径依从性还与死亡率降低（aHR：0.89，95% CI：0.79 - 1.00，p = 0.048）、血栓栓塞（aHR：0.78，95% CI：0.65 - 0.94，p = 0.0078）和MACE（aHR：0.82，95% CI：0.71 - 0.95，p = 0.0071）风险降低相关。在DoE分析中，达到的ABC标准数量增加与无事件生存期延长相关。
解读
房颤患者遵循ABC路径与包括死亡、血栓栓塞和MACE在内的主要不良事件风险降低相关。这凸显了在房颤患者临床护理中使用ABC路径的重要性。
资助
本研究由勃林格殷格翰公司资助。
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