Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2, Wanglang Rd, Bangkok 10700, Thailand.
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
Europace. 2024 Aug 30;26(9). doi: 10.1093/europace/euae237.
Compliance with integrated care based on the Atrial fibrillation Better Care (ABC) pathway has been associated with improved clinical outcomes. The primary objective of this study was to compare clinical outcomes of AF patients according to the compliant status of each component of the ABC pathway in a hierarchical win ratio approach.
We studied AF patients in the COOL-AF registry. Each patient was followed every 6 months until 3 years. A win ratio analysis was performed, as not all clinical outcomes are equivalent. The hierarchical outcomes were (1) all-cause death, (2) intracranial haemorrhage (ICH), (3) ischaemic stroke/systemic embolism, (4) non-ICH major bleedings, and (5) acute myocardial infarction or heart failure. We also assessed win ratio and win proportion variance over the follow-up time, and the variations over time. A total of 3405 patients (mean age 67.8 ± 11.3; 41.8% female) were studied. Win ratio of ABC-compliant (all three components) vs. ABC-not-compliant was 1.57 (1.35-1.83), P < 0.001. When adding time in therapeutic range (TTR) data for compliant criteria for those who were on warfarin, the win ratio increased to 2.28 (1.89-2.75), P < 0.001. The A-compliant group (plus TTR data), B-compliant, and C-compliant had the win ratio of 1.81 (1.51-2.12), 1.82 (1.53-2.16), and 1.39 (1.18-1.62), all P < 0.001, compared to not compliant group.
Management of AF patients according to each component of the ABC pathway is associated with better clinical outcomes compared to those non-compliant to ABC pathway. This finding underscores the importance of a holistic management approach strategy for AF patients.
基于心房颤动最佳护理（ABC）路径的综合护理依从性与改善临床结局相关。本研究的主要目的是通过分层赢率方法比较 ABC 路径各组成部分依从情况对 AF 患者临床结局的影响。
我们研究了 COOL-AF 登记处的 AF 患者。每位患者每 6 个月随访一次，随访时间长达 3 年。进行了赢率分析，因为并非所有临床结局都是等效的。分层结局为：（1）全因死亡；（2）颅内出血（ICH）；（3）缺血性卒中和全身性栓塞；（4）非 ICH 大出血；（5）急性心肌梗死或心力衰竭。我们还评估了随访期间赢率和赢率方差的变化以及随时间的变化。共纳入 3405 例患者（平均年龄 67.8±11.3 岁，41.8%为女性）。ABC 依从组（全部三个组成部分）与 ABC 不依从组的赢率为 1.57（1.35-1.83），P<0.001。对于服用华法林的患者，将符合标准的治疗时间范围（TTR）数据加入 ABC 依从性标准后，赢率增加至 2.28（1.89-2.75），P<0.001。A 组（加 TTR 数据）、B 组和 C 组的赢率分别为 1.81（1.51-2.12）、1.82（1.53-2.16）和 1.39（1.18-1.62），与不依从组相比，均 P<0.001。
与不依从 ABC 路径的患者相比，根据 ABC 路径的每个组成部分管理 AF 患者与更好的临床结局相关。这一发现强调了为 AF 患者实施整体管理策略的重要性。
