房颤患者ABC路径依从性状态变化与临床结局的关系：来自COOL-AF注册研究的报告

Relation of changes in ABC pathway compliance status to clinical outcomes in patients with atrial fibrillation: a report from the COOL-AF registry.

作者信息

Krittayaphong Rungroj, Chichareon Ply, Methavigul Komsing, Treewaree Sukrit, Lip Gregory Y H

机构信息

Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.

Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.

出版信息

Eur Heart J Qual Care Clin Outcomes. 2025 May 1;11(3):239-248. doi: 10.1093/ehjqcco/qcae039.

DOI:10.1093/ehjqcco/qcae039

PMID:38794883

Abstract

AIMS

The Atrial fibrillation Better Care (ABC) pathway provides a framework for holistic care management of atrial fibrillation (AF) patients. This study aimed to determine the impact of changes in compliance to ABC pathway management on clinical outcomes.

METHODS AND RESULTS

This is a prospective multicenter AF registry. Patients with non-valvular AF were enrolled and followed-up for 3 years. Baseline and follow-up compliance to the ABC pathway was assessed. The main outcomes were all-cause death, ischaemic stroke/systemic embolism, major bleeding, and heart failure. There studied 3096 patients (mean age 67.6 ± 11.1 years, 41.8% female). Patients were categorized into four groups: Group 1: ABC compliant at baseline and 1 year [n = 1022 (33.0%)]; Group 2: ABC non-compliant at baseline but compliant at 1 year [n = 307 (9.9%)]; Group 3: ABC compliant at baseline and non-compliant at 1 year [n = 312 (10.1%)]; and Group 4: ABC non-compliant at baseline and also at 1 year [n = 1455 (47.0%)]. The incidence rates [95% confidence intervals (CI)] of the composite outcome for Group 1-4 were 5.56 (4.54-6.74), 7.42 (5.35-10.03), 9.74 (7.31-12.70), and 11.57 (10.28-12.97), respectively. With Group 1 as a reference, Group 2-4 had hazard ratios (95% CI) of the composite outcome of 1.32 (0.92-1.89), 1.75 (1.26-2.43), and 2.07 (1.65-2.59), respectively.

CONCLUSION

Re-evaluation of compliance status of the ABC pathway management is needed to optimize integrated care management and improve clinical outcomes. AF patients who were ABC pathway compliant at baseline and also at follow-up had the best clinical outcomes.

摘要

目的

房颤优化照护（ABC）路径为房颤（AF）患者的整体照护管理提供了一个框架。本研究旨在确定ABC路径管理依从性的变化对临床结局的影响。

方法与结果

这是一项前瞻性多中心房颤注册研究。纳入非瓣膜性房颤患者并随访3年。评估ABC路径的基线和随访依从性。主要结局为全因死亡、缺血性卒中和/或体循环栓塞、大出血和心力衰竭。共研究了3096例患者（平均年龄67.6±11.1岁，41.8%为女性）。患者分为四组：第1组：基线和1年时均符合ABC路径[n = 1022例（33.0%）]；第2组：基线时不符合ABC路径但1年时符合[n = 307例（9.9%）]；第3组：基线时符合ABC路径但1年时不符合[n = 312例（10.1%）]；第4组：基线和1年时均不符合ABC路径[n = 1455例（47.0%）]。第1 - 4组复合结局的发生率[95%置信区间（CI）]分别为5.56（4.54 - 6.74）、7.42（5.35 - 10.03）、9.74（7.31 - 12.70）和11.57（10.28 - 12.97）。以第1组作为参照，第2 - 4组复合结局的风险比（95% CI）分别为1.32（0.92 - 1.89）、1.75（1.26 - 2.43）和2.07（1.65 - 2.59）。