AUTHOR=Esteve-Pastor María Asunción , Ruiz-Ortiz Martín , Muñiz Javier , Roldán-Rabadán Inmaculada , Otero Déborah , Cequier Ángel , Bertomeu-Martínez Vicente , Badimón Lina , Anguita Manuel , Lip Gregory Y. H. , Marín Francisco 

TITLE=Impact of Integrated Care Management on Clinical Outcomes in Atrial Fibrillation Patients: A Report From the FANTASIIA Registry

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.856222

DOI=10.3389/fcvm.2022.856222

ISSN=2297-055X

ABSTRACT=Background An integrated approach is increasingly advocated in patients with atrial fibrillation (AF), based on the ‘Atrial fibrillation Better Care (ABC) pathway:  A, Avoid stroke; B, better symptom management; C, Cardiovascular risk management. Our aim was to examine the prevalence to adherence to each component of ABC-pathway and its impact on long-term prognosis in “real-world” cohort of AF patients from the FANTASIIA registry.
Methods. Our prospectively study included consecutively AF outpatients anticoagulated with direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA). From the ABC pathway, adherence with the “A criterion” was defined by a Time in Therapeutic Range TTR≥70% or correct DOAC dose; “B criterion” adherence was defined by a European Heart Rhythm Association (EHRA) symptom scale I-II; and “C criterion” adherence as optimized risk factors and comorbidities. Baseline features and adverse event rates up to 3-years of follow-up were analyzed. Cox multivariate analysis was performed to investigate the role of each component of ABC-pathway in predicting major events.
Results 1,955 AF patients (74.4±9.4 years; 43.2% female) were included: 920(47.1%) patients were adherent with the A criterion; 1,791(91.6%) were adherent with B criterion; and 682(34.8%) were adherent with the C criterion. Only 394(20.2%) of whole population were managed fully adherent according to 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 to non-adherence. Adherence to 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 MACE [HR 0.41, 95%CI (0.28-0.62);p<0.001] compared to non-adherence. AF patients with C-criterion adherence had 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 with a 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 ABC-pathway. AF managed according to the ABC-Pathway was associated with a significant reduction of adverse outcomes during long follow-up, suggesting the benefit of holistic and integrated approach to AF management.