Integrated Care of Atrial Fibrillation Using the ABC (Atrial fibrillation Better Care) Pathway Improves Clinical Outcomes in Chinese Population: An Analysis From the Chinese Atrial Fibrillation Registry

Background: An integrated or holistic management approach has been proposed to improve the management of patients with atrial fibrillation (AF), based on the ‘Atrial fibrillation Better Care’ (ABC) pathway: ‘A’ Avoid stroke; ‘B’ Better symptom control with rate or rhythm control strategies; ‘C’ Cardiovascular risk factor and Comorbidity optimization. We aimed to evaluate the impact of ABC pathway compliance on outcomes in a Chinese AF cohort. Method and results: From the Chinese Atrial Fibrillation registry (CAFR) dataset, a total of 19,187 nonvalvular AF patients were enrolled, of which 4.365 (22.8%) were ABC pathway compliant (ABC group). Over a median follow-up of 4.1±1.8 years, patients in ABC group had lower rates of all-cause death (2.7% vs. 1.1%, p＜0.001), ischemic stroke (1.3% vs. 0.8%, p＜0.001) and the composite outcome (3.8% vs. 1.9%, p＜0.001). Cox multivariable regression analysis showed ABC pathway compliance was independently associated with a lower risk of all-cause death (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.70-0.95) and the composite outcome (HR, 0.86; 95% CI, 0.76-0.96). With an increasing numbers of ABC pathway criteria fulfilled, the risks of all-cause death and composite outcome were progressively lowered. Conclusion: In a large cohort of Chinese AF patients, ABC pathway compliance was associated with a lower risk for all-cause death and composite outcome of all-cause death, ischemic stroke and intracranial hemorrhage. An increasing number of ABC criteria fulfilled was associated with a progressively lower risk of adverse clinical outcomes. Key words: atrial fibrillation; mortality; ABC pathway; Integrated care