Kaolawanich Yodying, Winijkul Arjbordin, Yindeengam Ahthit, Sairat Poom, Lip Gregory Y H, Krittayaphong Rungroj
Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
Heliyon. 2024 Dec 31;11(1):e41586. doi: 10.1016/j.heliyon.2024.e41586. eCollection 2025 Jan 15.
Identifying asymptomatic patients with atrial fibrillation (AF) poses a challenge, and their optimal management is less certain, despite similar outcomes to symptomatic AF patients. The 'Atrial fibrillation Better Care' (ABC) pathway has been recently proposed as a holistic or integrated care approach for the comprehensive management of symptomatic patients with AF. We aimed to determine the use of the ABC pathway on clinical outcomes in asymptomatic patients with AF.
This is a prospective multicenter registry of patients with non-valvular AF in Thailand conducted between 2014 and 2017. Patients were characterized based on AF-related symptoms at enrollment and their adherence or non-adherence to the ABC pathway. Follow-up data were collected for 3 years to examine the composite endpoint (all-cause death, ischemic stroke/transient ischemic attack [TIA]/systemic embolism [SE], and major bleeding), and the impact of adherence to the ABC pathway.
Of a total of 3405 patients included in the study, 785 (23 %) (mean age 69.0 years, 63.7 % male) were asymptomatic at enrollment. Among these asymptomatic patients, 346 (44 %) were adherent to the ABC pathway. Adherence to the ABC pathway was associated with a significantly lower rate of composite endpoints compared to non-adherence (hazard ratio [HR] 0.63, 95 % confidence interval [CI] 0.45-0.90, p = 0.01). Adherence to the ABC pathway was also associated with lower all-cause mortality rates (HR 0.55, 95 % CI 0.35-0.85, p = 0.007). After adjusting for age, gender, and baseline comorbidities, adherence to the ABC pathway remained significantly associated with a lower rate of composite endpoints (HR 0.69, 95 % CI 0.49-0.98, p = 0.03) and all-cause death (HR 0.58, 95 % CI 0.38-0.90, p = 0.01) compared to non-adherence. Subgroup analyses based on sex, age, AF type, risk scores, and comorbidities consistently demonstrated lower hazard ratios for the composite endpoint among patients who were adherent to the ABC pathway.
In patients with AF who were asymptomatic, adherence to the ABC pathway was associated with a lower composite endpoint of all-cause death, ischemic stroke/TIA/SE, and major bleeding. This benefit was seen irrespective of sex, age, AF type, risk scores, and comorbidities.
识别无症状房颤（AF）患者具有挑战性，尽管其结局与有症状的房颤患者相似，但其最佳管理方式仍不太明确。“房颤更佳护理”（ABC）路径最近被提出作为一种全面或综合的护理方法，用于有症状房颤患者的综合管理。我们旨在确定ABC路径在无症状房颤患者临床结局中的应用情况。
这是一项于2014年至2017年在泰国进行的非瓣膜性房颤患者前瞻性多中心注册研究。患者在入组时根据房颤相关症状以及对ABC路径的依从或不依从情况进行特征描述。收集3年的随访数据，以检查复合终点（全因死亡、缺血性卒中/短暂性脑缺血发作[TIA]/全身性栓塞[SE]和大出血）以及对ABC路径依从性的影响。
在纳入研究的3405例患者中，785例（23%）（平均年龄69.0岁，男性占63.7%）在入组时无症状。在这些无症状患者中，346例（44%）依从ABC路径。与不依从相比，依从ABC路径与复合终点发生率显著降低相关（风险比[HR]0.63，95%置信区间[CI]0.45 - 0.90，p = 0.01）。依从ABC路径还与全因死亡率降低相关（HR 0.55，95% CI 0.35 - 0.85，p = 0.007）。在调整年龄、性别和基线合并症后，与不依从相比，依从ABC路径仍与较低的复合终点发生率（HR 0.69，95% CI 0.49 - 0.98，p = 0.03）和全因死亡（HR 0.58，95% CI 0.38 - 0.90，p = 0.01）显著相关。基于性别、年龄、房颤类型、风险评分和合并症的亚组分析一致显示，依从ABC路径患者的复合终点风险比更低。
在无症状的房颤患者中
