Clinical complexity and the impact of the ABC pathway in patients with atrial fibrillation

  • 01 December 2022

The approach to treating patients with atrial fibrillation (AF) has undergone significant changes recently because of growing awareness of clinical complexity. Multimorbidity, polypharmacy, and frailty have been repeatedly described in AF patients, and numerous reports have detailed their negative effects on the caliber of treatment and important outcomes. Despite their frequent coexistence and overlap, each of these phenomena plays a unique role in influencing prognosis.  

Recent guidelines on AF have recommended appropriate patient characterization and evaluation, followed by a holistic or integrated care approach to AF management, based on the "Atrial Fibrillation Better Care" (ABC) pathway approach to streamline a comprehensive and holistic management of AF patients. 

The ABC pathway has 3 main pillars:  

  1. “A” Avoid stroke (with Anticoagulants);  
  2. “B” Better symptom management, with patient‐centred decisions on rate or rhythm control; 
  3. “C” Cardiovascular and Comorbidity risk optimization. 

However, there are limited data on its usefulness among clinically complex patients. The Liverpool Centre for Cardiovascular Science, together with other notorious academic and research institutions, carried out a study to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. 

The Consortium partners of AFFIRMO from Liverpool Centre for Cardiovascular Science (UK), University of Murcia (IT),  Liverpool Centre of Cardiovascular Science (UK) and Aalborg University (DK).  

By clinically analysing complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy, the impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. 

The conclusion is incredibly interesting for AFFIRMO: ABC-adherent approach reduces the risk of major outcomes in AF patients characterized by clinical features of complexity (i.e., frailty, multimorbidity and poly- pharmacy). Pointing out that, ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients.  

AFFIRMO aims to move towards a patient-centred holistic care pathway for the management of older patients with multimorbidity and works to ensure adherence to the ABC pathway.  

The study results were published on BMC Medicine, the flagship medical journal of the BMC series. 

Click here to access the full article  

Source: Romiti, G.F., Proietti, M., Vitolo, M. et al. Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EUR Observational Research Programme in AF General Long-Term Registry. BMC Med 20, 326 (2022).