The science underpinning AFFIRMO: The ABC pathway

  • 23 August 2021

The AFFIRMO project aims to develop a new clinical pathway for treating older patients with multimorbidity, including Atrial Fibrillation (AF). The challenge is to move from fragmentation to an integrated care strategy designed to be patient-centred. AFFIRMO's answer to this challenge is to develop a holistic care approach based on the 'Atrial Fibrillation Better Care'(ABC) model.

What is the ABC model?

The Atrial Fibrillation Better Care model was proposed in 2017 to streamline and simplify the management of atrial fibrillation patients. This simple model focuses on three main components:

  1. The ‘A’ criterion (Avoid stroke) refers to the management of thromboembolic and bleeding risks by appropriate prescription and use of specific drugs
  2. The ‘B’ criterion (Better symptom management) aims to reduce and control symptom burden by actively involving the patient in the control therapy
  3. The ‘C’ criterion (Cardiovascular and Comorbidity risk optimisation) address concomitant comorbidity and cardiovascular risk factors. The aim is to optimise the management of these parallel complications. 

Each of the three components is essential to reduce the risk of adverse outcomes in patients with atrial fibrillation. 

Why do we need to address Atrial Fibrillation? 

Atrial fibrillation is the most common heart rhythm disorder: 1 in 3 adults are at risk of developing it in their lifetime. Patients with AF are exposed to a higher risk of stroke, death, dementia and heart failure. 

In the last 40 years, the absolute number of AF patients has almost doubled, with prevalence in middle and low-income countries. This trend represents a public health burden, especially considering the impact of AF on mortality and the higher healthcare-associated costs. A more efficient way to cure patients affected by AF is therefore needed. 

Does the ABC model represent a viable solution?

A recent study on the impact of ABC in patients with Atrial Fibrillation (1) showed its effectiveness. From a systematic review of clinical studies involving the ABC approach, researchers concluded that the pathway was associated with a significant reduction in the risk of adverse outcomes. The risk reduction observed in the study for major clinical events with ABC pathway compliance ranged from 30% less major bleeding to 63% lowered cardiovascular deaths, as displayed in the infographic below. 


The positive results highlighted in the research strengthen the view that this evidence-based approach should be translated into daily clinical practice, together with longer follow-up. 

Despite the several advantages associated with the ABC pathway, the adherence to the model is still sub-optimal. Researchers observed that the ABC approach was applied just in one of every five AF. Moreover, the analyses showed that the increasing clinical complexity directly affects the effectiveness of an integrated management strategy.

The way to mainstream this approach is still long. AFFIRMO project is moving toward this objective by developing a ready-to-deploy solution. Over the next five years, researchers will leverage European resources to deliver a digital and patient-centred approach to manage multimorbidity.



  1. Adherence to the 'Atrial Fibrillation Better Care' Pathway in Patients with Atrial Fibrillation: Impact on Clinical Outcomes-A Systematic Review and Meta-Analysis of 285,000 Patients.

Romiti GF, Pastori D, Rivera-Caravaca JM, Ding WY, Gue YX, Menichelli D, Gumprecht J, Kozieł M, Yang PS, Guo Y, Lip GYH, Proietti M. - Thromb Haemost. 2021 May 21. doi: 10.1055/a-1515-9630.