학술논문

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry
Document Type
Report
Author
Romiti, Giulio FrancescoProietti, MarcoVitolo, MarcoBonini, NiccolòFawzy, Ameenathul MazayaDing, Wern YewFauchier, LaurentMarin, FranciscoNabauer, MichaelDan, Gheorghe AndreiPotpara, Tatjana S.Boriani, GiuseppeLip, Gregory Y. H.Tavazzi, L.Maggioni, A. P.Kalarus, Z.Ferrari, R.Shantsila, A.Goda, A.Mairesse, G.Shalganov, T.Antoniades, L.Taborsky, M.Riahi, S.Muda, P.García Bolao, I.Piot, O.Etsadashvili, K.Simantirakis, E. N.Haim, M.Azhari, A.Najafian, J.Santini, M.Mirrakhimov, E.Kulzida, K.Erglis, A.Poposka, L.Burg, M. R.Crijns, H.Erküner, ü.Atar, D.Lenarczyk, R.Oliveira, M. MartinsShah, D.Serdechnaya, E.Diker, E.Lane, D.Zëra, E.Ekmekçiu, U.Paparisto, V.Tase, M.Gjergo, H.Dragoti, J.Goda, A.Ciutea, M.Ahadi, N.el Husseini, Z.Raepers, M.Leroy, J.Haushan, P.Jourdan, A.Lepiece, C.Desteghe, L.Vijgen, J.Koopman, P.Van Genechten, G.Heidbuchel, H.Boussy, T.De Coninck, M.Van Eeckhoutte, H.Bouckaert, N.Friart, A.Boreux, J.Arend, C.Evrard, P.Stefan, L.Hoffer, E.Herzet, J.Massoz, M.Celentano, C.Sprynger, M.Pierard, L.Melon, P.Van Hauwaert, B.Kuppens, C.Faes, D.Van Lier, D.Van Dorpe, A.Gerardy, A.Deceuninck, O.Xhaet, O.Dormal, F.Ballant, E.Blommaert, D.Yakova, D.Hristov, M.Yncheva, T.Stancheva, N.Tisheva, S.Tokmakova, M.Nikolov, F.Gencheva, D.Shalganov, T.Kunev, B.Stoyanov, M.Marchov, D.Gelev, V.Traykov, V.Kisheva, A.Tsvyatkov, H.Shtereva, R.Bakalska-Georgieva, S.Slavcheva, S.Yotov, Y.Kubícková, M.Joensen, A. MarniGammelmark, A.Rasmussen, L. HvilstedDinesen, P.Riahi, S.Vena, S. KroghSorensen, B.Korsgaard, A.Andersen, K.Hellum, C. FragtrupSvenningsen, A.Nyvad, O.Wiggers, P.May, O.Aarup, A.Graversen, B.Jensen, L.Andersen, M.Svejgaard, M.Vester, S.Hansen, S.Lynggaard, V.Ciudad, M.Vettus, R.Muda, P.Maestre, A.Castaéo, S.Cheggour, S.Poulard, J.Mouquet, V.Leparrée, S.Bouet, J.Taieb, J.Doucy, A.Duquenne, H.Furber, A.Dupuis, J.Rautureau, J.Font, M.Damiano, P.Lacrimini, M.Abalea, J.Boismal, S.Menez, T.Mansourati, J.Range, G.Gorka, H.Laure, C.Vassalière, C.Elbaz, N.Lellouche, N.Djouadi, K.Roubille, F.Dietz, D.Davy, J.Granier, M.Winum, P.Leperchois-Jacquey, C.Kassim, H.Marijon, E.Le Heuzey, J.Fedida, J.Maupain, C.Himbert, C.Gandjbakhch, E.Hidden-Lucet, F.Duthoit, G.Badenco, N.Chastre, T.Waintraub, X.Oudihat, M.Lacoste, J.Stephan, C.Bader, H.Delarche, N.Giry, L.Arnaud, D.Lopez, C.Boury, F.Brunello, I.Lefèvre, M.Mingam, R.Haissaguerre, M.Le Bidan, M.Pavin, D.Le Moal, V.Leclercq, C.Piot, O.Beitar, T.Martel, I.Schmid, A.Sadki, N.Romeyer-Bouchard, C.Da Costa, A.Arnault, I.Boyer, M.Piat, C.Lozance, N.Nastevska, S.Doneva, A.Fortomaroska Milevska, B.Sheshoski, B.Petroska, K.Taneska, N.Bakrecheski, N.Lazarovska, K.Jovevska, S.Ristovski, V.Antovski, A.Lazarova, E.Kotlar, I.Taleski, J.Poposka, L.Kedev, S.Zlatanovik, N.Jordanova, S.Bajraktarova Proseva, T.Doncovska, S.Maisuradze, D.Esakia, A.Sagirashvili, E.Lartsuliani, K.Natelashvili, N.Gumberidze, N.Gvenetadze, R.Etsadashvili, K.Gotonelia, N.Kuridze, N.Papiashvili, G.Menabde, I.Glöggler, S.Napp, A.Lebherz, C.Romero, H.Schmitz, K.Berger, M.Zink, M.Köster, S.Sachse, J.Vonderhagen, E.Soiron, G.Mischke, K.Reith, R.Schneider, M.Rieker, W.Boscher, D.Taschareck, A.Beer, A.Oster, D.Ritter, O.Adamczewski, J.Walter, S.Frommhold, A.Luckner, E.Richter, J.Schellner, M.Landgraf, S.Bartholome, S.Naumann, R.Schoeler, J.Westermeier, D.William, F.Wilhelm, K.Maerkl, M.Oekinghaus, R.Denart, M.Kriete, M.Tebbe, U.Scheibner, T.Gruber, M.Gerlach, A.Beckendorf, C.Anneken, L.Arnold, M.Lengerer, S.Bal, Z.Uecker, C.Förtsch, H.Fechner, S.Mages, V.Martens, E.Methe, H.Schmidt, T.Schaeffer, B.Hoffmann, B.Moser, J.Heitmann, K.Willems, S.Willems, S.Klaus, C.Lange, I.Durak, M.Esen, E.Mibach, F.Mibach, H.Utech, A.Gabelmann, M.Stumm, R.Ländle, V.Gartner, C.Goerg, C.Kaul, N.Messer, S.Burkhardt, D.Sander, C.Orthen, R.Kaes, S.Baumer, A.Dodos, F.Barth, A.Schaeffer, G.Gaertner, J.Winkler, J.Fahrig, A.Aring, J.Wenzel, I.Steiner, S.Kliesch, A.Kratz, E.Winter, K.Schneider, P.Haag, A.Mutscher, I.Bosch, R.Taggeselle, J.Meixner, S.Schnabel, A.Shamalla, A.Hötz, H.Korinth, A.Rheinert, C.Mehltretter, G.Schön, B.Schön, N.Starflinger, A.Englmann, E.Baytok, G.Laschinger, T.Ritscher, G.Gerth, A.Dechering, D.Eckardt, L.Kuhlmann, M.Proskynitopoulos, N.Brunn, J.Foth, K.Axthelm, C.Hohensee, H.Eberhard, K.Turbanisch, S.Hassler, N.Koestler, A.Stenzel, G.Kschiwan, D.Schwefer, M.Neiner, S.Hettwer, S.Haeussler-Schuchardt, M.Degenhardt, R.Sennhenn, S.Steiner, S.Brendel, M.Stoehr, A.Widjaja, W.Loehndorf, S.Logemann, A.Hoskamp, J.Grundt, J.Block, M.Ulrych, R.Reithmeier, A.Panagopoulos, V.Martignani, C.Bernucci, D.Fantecchi, E.Diemberger, I.Ziacchi, M.Biffi, M.Cimaglia, P.Frisoni, J.Giannini, I.Boni, S.Fumagalli, S.Pupo, S.Di Chiara, A.Mirone, P.Fantecchi, E.Pesce, F.Zoccali, C.Malavasi, V. L.Mussagaliyeva, A.Ahyt, B.Salihova, Z.Koshum-Bayeva, K.Kerimkulova, A.Bairamukova, A.Mirrakhimov, E.Lurina, B.Zuzans, R.Jegere, S.Mintale, I.Kupics, K.Jubele, K.Erglis, A.Kalejs, O.Vanhear, K.Burg, M.Cachia, M.Abela, E.Warwicker, S.Tabone, T.Xuereb, R.Asanovic, D.Drakalovic, D.Vukmirovic, M.Pavlovic, N.Music, L.Bulatovic, N.Boskovic, A.Uiterwaal, H.Bijsterveld, N.De Groot, J.Neefs, J.van den Berg, N.Piersma, F.Wilde, A.Hagens, V.Van Es, J.Van Opstal, J.Van Rennes, B.Verheij, H.Breukers, W.Tjeerdsma, G.Nijmeijer, R.Wegink, D.Binnema, R.Said, S.Erküner, ü.Philippens, S.van Doorn, W.Crijns, H.Szili-Torok, T.Bhagwandien, R.Janse, P.Muskens, A.van Eck, M.Gevers, R.van der Ven, N.Duygun, A.Rahel, B.Meeder, J.Vold, A.Holst Hansen, C.Engset, I.Atar, D.Dyduch-Fejklowicz, B.Koba, E.Cichocka, M.Sokal, A.Kubicius, A.Pruchniewicz, E.Kowalik-Sztylc, A.Czapla, W.Mróz, I.Kozlowski, M.Pawlowski, T.Tendera, M.Winiarska-Filipek, A.Fidyk, A.Slowikowski, A.Haberka, M.Lachor-Broda, M.Biedron, M.Gasior, Z.KoÅodziej, M.Janion, M.Gorczyca-Michta, I.Wozakowska-Kaplon, B.Stasiak, M.Jakubowski, P.Ciurus, T.Drozdz, J.Simiera, M.Zajac, P.Wcislo, T.Zycinski, P.Kasprzak, J.Olejnik, A.Harc-Dyl, E.Miarka, J.Pasieka, M.ZiemiÅska-ÅuÄ, M.Bujak, W.ÅliwiÅski, A.Grech, A.Morka, J.Petrykowska, K.PrasaÅ, M.HordyÅski, G.Feusette, P.Lipski, P.Wester, A.Streb, W.Romanek, J.Woźniak, P.ChlebuÅ, M.Szafarz, P.Stanik, W.Zakrzewski, M.Kaźmierczak, J.Przybylska, A.Skorek, E.BÅaszczyk, H.StÄpieÅ, M.Szabowski, S.Krysiak, W.SzymaÅska, M.KarasiÅski, J.Blicharz, J.Skura, M.HaÅas, K.Michalczyk, L.Orski, Z.Krzyżanowski, K.Skrobowski, A.ZieliÅski, L.Tomaszewska-Kiecana, M.DÅużniewski, M.Kiliszek, M.Peller, M.Budnik, M.Balsam, P.Opolski, G.TymiÅska, A.OzieraÅski, K.Wancerz, A.Borowiec, A.Majos, E.Dabrowski, R.Szwed, H.Musialik-Lydka, A.Leopold-Jadczyk, A.Jedrzejczyk-Patej, E.Koziel, M.Lenarczyk, R.Mazurek, M.Kalarus, Z.Krzemien-Wolska, K.Starosta, P.Nowalany-Kozielska, E.Orzechowska, A.Szpot, M.Staszel, M.Almeida, S.Pereira, H.Brandão Alves, L.Miranda, R.Ribeiro, L.Costa, F.Morgado, F.Carmo, P.Galvao Santos, P.Bernardo, R.Adragão, P.Ferreira da Silva, G.Peres, M.Alves, M.Leal, M.Cordeiro, A.Magalhães, P.Fontes, P.Leão, S.Delgado, A.Costa, A.Marmelo, B.Rodrigues, B.Moreira, D.Santos, J.Santos, L.Terchet, A.Darabantiu, D.Mercea, S.Turcin Halka, V.Pop Moldovan, A.Gabor, A.Doka, B.Catanescu, G.Rus, H.Oboroceanu, L.Bobescu, E.Popescu, R.Dan, A.Buzea, A.Daha, I.Dan, G.Neuhoff, I.Baluta, M.Ploesteanu, R.Dumitrache, N.Vintila, M.Daraban, A.Japie, C.Badila, E.Tewelde, H.Hostiuc, M.Frunza, S.Tintea, E.Bartos, D.Ciobanu, A.Popescu, I.Toma, N.Gherghinescu, C.Cretu, D.Patrascu, N.Stoicescu, C.Udroiu, C.Bicescu, G.Vintila, V.Vinereanu, D.Cinteza, M.Rimbas, R.Grecu, M.Cozma, A.Boros, F.Ille, M.Tica, O.Tor, R.Corina, A.Jeewooth, A.Maria, B.Georgiana, C.Natalia, C.Alin, D.Dinu-Andrei, D.Livia, M.Daniela, R.Larisa, R.Umaar, S.Tamara, T.Popescu, M. IoachimNistor, D.Sus, I.Coborosanu, O.Alina-Ramona, N.Dan, R.Petrescu, L.Ionescu, G.Popescu, I.Vacarescu, C.Goanta, E.Mangea, M.Ionac, A.Mornos, C.Cozma, D.Pescariu, S.Solodovnicova, E.Soldatova, I.Shutova, J.Tjuleneva, L.Zubova, T.Uskov, V.Obukhov, D.Rusanova, G.Soldatova, I.Isakova, N.Odinsova, S.Arhipova, T.Kazakevich, E.Serdechnaya, E.Zavyalova, O.Novikova, T.Riabaia, I.Zhigalov, S.Drozdova, E.Luchkina, I.Monogarova, Y.Hegya, D.Rodionova, L.Rodionova, L.Nevzorova, V.Soldatova, I.Lusanova, O.Arandjelovic, A.Toncev, D.Milanov, M.Sekularac, N.Zdravkovic, M.Hinic, S.Dimkovic, S.Acimovic, T.Saric, J.Polovina, M.Vujisic-Tesic, B.Nedeljkovic, M.Zlatar, M.Asanin, M.Vasic, V.Popovic, Z.Djikic, D.Sipic, M.Peric, V.Dejanovic, B.Milosevic, N.Stevanovic, A.Andric, A.Pencic, B.Pavlovic-Kleut, M.Celic, V.Pavlovic, M.Petrovic, M.Vuleta, M.Petrovic, N.Simovic, S.Savovic, Z.Milanov, S.Davidovic, G.Iric-Cupic, V.Simonovic, D.Stojanovic, M.Stojanovic, S.Mitic, V.Ilic, V.Petrovic, D.Deljanin Ilic, M.Ilic, S.Stoickov, V.Markovic, S.Kovacevic, S.García Fernandez, A.Perez Cabeza, A.Anguita, M.Tercedor Sanchez, L.Mau, E.Loayssa, J.Ayarra, M.Carpintero, M.Roldán Rabadan, I.Leal, M.Ortega, M. GilTello Montoliu, A.Orenes Piéero, E.Manzano Fernández, S.Marín, F.Romero Aniorte, A.Veliz Martínez, A.Quintana Giner, M.Ballesteros, G.Palacio, M.Alcalde, O.García-Bolao, I.Bertomeu Gonzalez, V.Otero-Raviéa, F.García Seara, J.Gonzalez Juanatey, J.Dayal, N.Maziarski, P.Gentil-Baron, P.Shah, D.Koç, M.Onrat, E.Dural, I. E.Yilmaz, K.üzin, B.Kurklu, S. TanAtmaca, Y.Canpolat, U.Tokgozoglu, L.Dolu, A. K.Demirtas, B.Sahin, D.Ozcan Celebi, O.Diker, E.Gagirci, G.Turk, U. O.Ari, H.Polat, N.Toprak, N.Sucu, M.Akin Serdar, O.Taha Alper, A.Kepez, A.Yuksel, Y.Uzunselvi, A.Yuksel, S.Sahin, M.Kayapinar, O.Ozcan, T.Kaya, H.Yilmaz, M. B.Kutlu, M.Demir, M.Gibbs, C.Kaminskiene, S.Bryce, M.Skinner, A.Belcher, G.Hunt, J.Stancombe, L.Holbrook, B.Peters, C.Tettersell, S.Shantsila, A.Lane, D.Senoo, K.Russell, K.Domingos, P.Hussain, S.Partridge, J.Haynes, R.Bahadur, S.Brown, R.McMahon, S.McDonald, J.Balachandran, K.Singh, R.Garg, S.Desai, H.Davies, K.Goddard, W.Galasko, G.Rahman, I.Chua, Y.Payne, O.Preston, S.Brennan, O.Pedley, L.Whiteside, C.Dickinson, C.Brown, J.Jones, K.Benham, L.Brady, R.Buchanan, L.Ashton, A.Crowther, H.Fairlamb, H.Thornthwaite, S.Relph, C.McSkeane, A.Poultney, U.Kelsall, N.Rice, P.Wilson, T.Wrigley, M.Kaba, R.Patel, T.Young, E.Law, J.Runnett, C.Thomas, H.McKie, H.Fuller, J.Pick, S.Sharp, A.Hunt, A.Thorpe, K.Hardman, C.Cusack, E.Adams, L.Hough, M.Keenan, S.Bowring, A.Watts, J.Zaman, J.Goffin, K.Nutt, H.Beerachee, Y.Featherstone, J.Mills, C.Pearson, J.Stephenson, L.Grant, S.Wilson, A.Hawksworth, C.Alam, I.Robinson, M.Ryan, S.Egdell, R.Gibson, E.Holland, M.Leonard, D.Mishra, B.Ahmad, S.Randall, H.Hill, J.Reid, L.George, M.McKinley, S.Brockway, L.Milligan, W.Sobolewska, J.Muir, J.Tuckis, L.Winstanley, L.Jacob, P.Kaye, S.Morby, L.Jan, A.Sewell, T.Boos, C.Wadams, B.Cope, C.Jefferey, P.Andrews, N.Getty, A.Suttling, A.Turner, C.Hudson, K.Austin, R.Howe, S.Iqbal, R.Gandhi, N.Brophy, K.Mirza, P.Willard, E.Collins, S.Ndlovu, N.Subkovas, E.Karthikeyan, V.Waggett, L.Wood, A.Bolger, A.Stockport, J.Evans, L.Harman, E.Starling, J.Williams, L.Saul, V.Sinha, M.Bell, L.Tudgay, S.Kemp, S.Brown, J.Frost, L.Ingram, T.Loughlin, A.Adams, C.Adams, M.Hurford, F.Owen, C.Miller, C.Donaldson, D.Tivenan, H.Button, H.Nasser, A.Jhagra, O.Stidolph, B.Brown, C.Livingstone, C.Duffy, M.Madgwick, P.Roberts, P.Greenwood, E.Fletcher, L.Beveridge, M.Earles, S.McKenzie, D.Beacock, D.Dayer, M.Seddon, M.Greenwell, D.Luxton, F.Venn, F.Mills, H.Rewbury, J.James, K.Roberts, K.Tonks, L.Felmeden, D.Taggu, W.Summerhayes, A.Hughes, D.Sutton, J.Felmeden, L.Khan, M.Walker, E.Norris, L.O'Donohoe, L.Mozid, A.Dymond, H.Lloyd-Jones, H.Saunders, G.Simmons, D.Coles, D.Cotterill, D.Beech, S.Kidd, S.Wrigley, B.Petkar, S.Smallwood, A.Jones, R.Radford, E.Milgate, S.Metherell, S.Cottam, V.Buckley, C.Broadley, A.Wood, D.Allison, J.Rennie, K.Balian, L.Howard, L.Pippard, L.Board, S.Pitt-Kerby, T.
Source
BMC Medicine. September 2, 2022, Vol. 20 Issue 1
Subject
Europe
Language
English
ISSN
1741-7015
Abstract
Background Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The 'Atrial fibrillation Better Care' (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58-0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52-0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58-0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56-0.98) and composite outcome (aHR: 0.76, 95%CI 0.60-0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients. Keywords: Atrial fibrillation, Integrated management, Outcomes, Clinical complexity
Author(s): Giulio Francesco Romiti[sup.1,2] , Marco Proietti[sup.1,3,4] , Marco Vitolo[sup.1,5,6] , Niccolò Bonini[sup.1,5] , Ameenathul Mazaya Fawzy[sup.1] , Wern Yew Ding[sup.1] , Laurent Fauchier[sup.7] , Francisco Marin[sup.8] , Michael Nabauer[sup.9] [...]