Fawzy Ameenathul Mazaya, Kotalczyk Agnieszka, Guo Yutao, Wang Yutang, Lip Gregory Y H
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland.
Intern Emerg Med. 2025 Apr 27. doi: 10.1007/s11739-025-03928-0.
The current Atrial fibrillation Better Care (ABC) pathway for holistic or integrated management of AF is associated with improved clinical outcomes; however, data on the very elderly (aged ≥ 85 years) are sparse.To evaluate the impact of ABC pathway on clinical outcomes amongst very elderly AF patients over a follow-up period of 1 year.The ChiOTEAF registry is a prospective, multicenter nationwide study conducted from October 2014 to December 2018. Endpoints of interest were the composite outcome of all-cause death/any thromboembolism (TE), all-cause death, TE events, and major bleeding.The eligible cohort included 1215 individuals (mean age 88.5 ± 3.3; 33.5% female), of which 142 (11.7%) were managed accordingly to the ABC pathway. ABC compliance was independently associated with lower odds of the composite outcome (odds Ratio (OR): 0.23; 95% confidence interval (CI): 0.08-0.66) and all-cause death (OR: 0.22; 95% CI: 0.07-0.75), without a significant increase in major bleeding compared to ABC non-compliance. Health-related quality of life (QOL) was also significantly higher in the ABC compliant group compared to the non-compliant group (EQ score 0.83 ± 0.17 vs. 0.78 ± 0.20; p = 0.004). Independent predictors of ABC non-compliance were prior major bleeding, chronic kidney disease, and dementia.Our findings suggest that adherence to the ABC pathway in very elderly patients is associated with significantly improved survival and health-related QOL.
目前用于心房颤动（AF）整体或综合管理的心房颤动更佳护理（ABC）路径与改善临床结局相关；然而，关于高龄（≥85岁）患者的数据却很稀少。为了评估ABC路径对高龄AF患者在1年随访期内临床结局的影响。ChiOTEAF注册研究是一项于2014年10月至2018年12月进行的前瞻性、多中心全国性研究。感兴趣的终点是全因死亡/任何血栓栓塞（TE）、全因死亡、TE事件和大出血的复合结局。符合条件的队列包括1215名个体（平均年龄88.5±3.3岁；33.5%为女性），其中142名（11.7%）按照ABC路径进行管理。ABC依从性与复合结局的较低几率（优势比（OR）：0.23；95%置信区间（CI）：0.08 - 0.66）和全因死亡（OR：0.22；95%CI：0.07 - 0.75）独立相关，与未依从ABC相比，大出血没有显著增加。与未依从组相比，ABC依从组的健康相关生活质量（QOL）也显著更高（EQ评分0.83±0.17 vs. 0.78±0.20；p = 0.004）。ABC不依从的独立预测因素是既往大出血、慢性肾病和痴呆。我们的研究结果表明，高龄患者坚持ABC路径与生存和健康相关QOL的显著改善相关。
