Impact of Integrated Care Management on Clinical Outcomes in Atrial Fibrillation Patients : A Report From the FANTASIIA Registry
Esteve-Pastor, María Asunción (Hospital Clínico Universitario Virgen de la Arrixaca (El Palmar, Múrcia))
Ruiz-Ortiz, Martín (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Muñiz, Javier (Instituto de Investigación Biomédica de A Coruña)
Roldán-Rabadán, Inmaculada (Hospital Universitario La Paz (Madrid))
Otero, Déborah (ODDS. SL)
Cequier, Ángel (Hospital Universitari de Bellvitge)
Bertomeu-Martínez, Vicente (Hospital Universitario de San Juan. Servicio de Cardiología)
Badimon, Lina (Institut d'Investigació Biomèdica Sant Pau)
Anguita-Sánchez, Manuel (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Lip, Gregory Y. H. (Aalborg Universitet. Department of Clinical Medicine)
Marín, Francisco (Hospital Clínico Universitario Virgen de la Arrixaca (El Palmar, Múrcia))

Data:	2022
Resum:	Background: An integrated and holistic approach is increasingly advocated in patients with atrial fibrillation (AF), based on the "Atrial fibrillation Better Care (ABC) pathway: A, Avoid stroke with anticoagulation; B, better symptom management; C, cardiovascular and comorbidity risk management. " The aim of this study was to examine the prevalence of adherence to each component of the ABC pathway and to analyze its impact on long-term prognosis in the "real-world" cohort of AF patients from the FANTASIIA registry. Methods: This prospective study included consecutive AF outpatients anticoagulated with direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA) from June 2013 to October 2014. From the ABC pathway, adherence to the "A criterion" was defined by a time in the therapeutic range (TTR) ≥ 70% or correct dose with DOAC; "B criterion" adherence was defined by a European Heart Rhythm Association (EHRA) Symptom Scale I-II; and "C criterion" adherence was defined as optimized risk factors and comorbidity management. Baseline features and embolic events, severe bleeding, and all-cause and cardiovascular mortality rates up to 3 years of follow-up were analyzed, and a Cox multivariate analysis was performed to investigate the role of each component of the ABC pathway in predicting major events. Results: A total of 1,955 AF patients (age: 74. 4 ± 9. 4 years; 43. 2% female patients) were included in this study: adherence to A criterion was observed in 920 (47. 1%) patients; adherence to B criterion was observed in 1,791 (91. 6%) patients; and adherence to C criterion was observed in 682 (34. 8%) patients. Only 394 (20. 2%) of the whole population had good control of AF according to the ABC pathway. After a median follow-up of 1,078 days (IQR: 766-1,113), adherence to A criterion was independently associated with reduced cardiovascular mortality [HR: 0. 67, 95%CI (0. 45-0. 99); p = 0. 048] compared with non-adherence. Adherence to the B criterion was independently associated with reduced stroke [HR: 0. 28, 95%CI (0. 14-0. 59); p < 0. 001], all-cause mortality [HR: 0. 49, 95%CI (0. 35-0. 69); p < 0. 001], cardiovascular mortality [HR: 0. 39, 95%CI (0. 25-0. 62); p < 0. 001], and major adverse cardiovascular events (MACE) [HR: 0. 41, 95%CI (0. 28-0. 62); p < 0. 001] compared with non-adherence. AF patients with C criterion adherence had a significantly lower risk of myocardial infarction [HR: 0. 31, 95%CI (0. 15-0. 66); p < 0. 001]. Fully adherent ABC patients had a significant reduction in MACE [HR: 0. 64, 95%CI (0. 42-0. 99); p = 0. 042]. Conclusion: In real-world anticoagulated AF patients from FANTASIIA registry, we observed a lack of adherence to integrated care management of AF following the ABC pathway. AF managed according to the ABC pathway was associated with a significant reduction in adverse outcomes during long follow-up, suggesting the benefit of a holistic and integrated approach to AF management.
Ajuts:	Instituto de Salud Carlos III RD16/11/00420 Ministerio de Economía y Competitividad RD12/0042/0068 Ministerio de Economía y Competitividad RD12/0042/0010 Ministerio de Economía y Competitividad RD12/0042/0069 Ministerio de Economía y Competitividad RD12/0042/0063 Ministerio de Economía y Competitividad RD12/0042/0049 Instituto de Salud Carlos III PI13/00513/FEDER
Nota:	Altres ajuts: Pfizer/Bristol-Myers Squibb; European Regional Development Fund (FEDER); Fundación Séneca (19245/PI/14); Instituto Murciano de Investigación Biosanitaria (IMIB16/AP/01/06).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Atrial fibrillation ; Patient adherence ; Risk factors ; ABC-pathway ; Integrated approach
Publicat a:	Frontiers in Cardiovascular Medicine, Vol. 9 (february 2022) , p. 856222, ISSN 2297-055X

DOI: 10.3389/fcvm.2022.856222
PMID: 35586656

12 p, 1.2 MB

El registre apareix a les col·leccions:
Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
Articles > Articles de recerca
Articles > Articles publicats