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The Atrial Fibrillation Better Care pathway for managing atrial fibrillation: a review
David Stevens1,2, Stephanie L Harrison1,2, Ruwanthi Kolamunnage-Dona3
1Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart & Chest Hospital, 6 West Derby Street, Liverpool L7 8TX, UK.
Insights
The Atrial Fibrillation Better Care (ABC) pathway improves patient outcomes. Adherence to the ABC pathway significantly reduces risks of stroke, heart attack, and death in atrial fibrillation patients.
Area of Science:
- Cardiology
- Public Health
Background:
- The 2020 European Society of Cardiology guidelines recommend the Atrial Fibrillation Better Care (ABC) pathway.
- The ABC pathway offers a structured approach to manage atrial fibrillation (AF).
- Key components include stroke prevention (A), symptom management (B), and risk factor reduction (C).
Purpose of the Study:
- To review definitions of ABC pathway criteria across studies.
- To assess the impact of ABC pathway adherence on clinical outcomes.
Main Methods:
- Systematic review of 12 studies.
- Analysis of seven distinct patient cohorts.
- Examination of adherence/non-adherence to ABC pathway criteria.
Main Results:
- Consistent statistically significant reductions in stroke risk.
- Significant reductions in myocardial infarction risk.
- Significant reductions in mortality rates among adherent patients.
Conclusions:
- The ABC pathway framework promotes consistent and equitable care for AF patients.
- Adherence to the ABC pathway is associated with improved clinical outcomes.
- Further research with consistent definitions and prospective cohorts is needed.
Abstract:
The 2020 European Society of Cardiology guidelines endorse the Atrial Fibrillation Better Care (ABC) pathway as a structured approach for the management of atrial fibrillation (AF), addressing three principal elements: 'A' - avoid stroke (with oral anticoagulation), 'B' - patient-focused better symptom management, and 'C' - cardiovascular and comorbidity risk factor reduction and management. This review summarizes the definitions used for the ABC criteria in different studies and the impact of adherence/non-adherence on clinical outcomes, from 12 studies on seven different cohorts. All studies consistently showed statistically significant reductions in the risk of stroke, myocardial infarction, and mortality among those with ABC pathway adherent treatment. The ABC pathway provides a simple decision-making framework to enable consistent equitable care from clinicians in primary and secondary/tertiary care. Further research examining the impact of ABC pathway implementation in prospective cohorts utilizing consistent inclusion criteria and definitions of 'A', 'B', and 'C' adherent care is warranted.
