• Marco Proietti, Marco Vitolo, and LipGregory Y HGYHLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, De.
• Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
• Eur. J. Clin. Invest. 2021 Jun 1; 51 (6): e13498.

BackgroundIntegrated care for management of atrial fibrillation (AF) patients has been associated with a reduction in adverse events. The 'Atrial fibrillation Better Care (ABC) pathway' has been proposed to streamline such integrated management. In this paper, we analysed the impact of ABC pathway adherent clinical management on outcomes in AF patients with high-risk 'metabolic' comorbidities (i.e. diabetes mellitus [DM], chronic kidney disease [CKD], metabolic syndrome [MetS].MethodsPatients from the SPORTIF III and V trials and with available data to evaluate ABC criteria were analysed. DM, CKD and MetS were evaluated according to baseline data. A composite of major adverse cardiovascular events and all-cause death was the study outcome.ResultsA total of 3637 patients (median age 72 [IQR 66-77], 30.3% female) were analysed. DM was evident in 23.4%, CKD in 25.8% and MetS in 31.5% among the overall cohort. Respectively, 23.2% were ABC pathway adherent in the DM subgroup, 21.2% in CKD and 23.7% in MetS subgroups. Composite outcome occurred less frequently in patients managed adherent to ABC pathway than those nonadherents, in all three groups. In the final multivariate model, ABC adherent care was inversely associated with a lower risk of composite outcome in the DM (HR 0.45, 95% CI 0.23-0.88), CKD (HR 0.60, 95% CI 0.36-0.98) and MetS (HR 0.37, 95% CI 0.19-0.71) subgroups.ConclusionsIn high-risk AF patients with DM, CKD and MetS, ABC pathway adherent management was associated with a lowered risk of the composite outcome of cardiovascular events, cardiovascular and all-cause death.© 2021 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

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