Compliance of atrial fibrillation treatment with the ABC pathway in patients with concomitant diabetes mellitus in the Middle East based on the Gulf SAFE registry

Abstract

Introduction Atrial fibrillation (AF) and diabetes mellitus (DM) constitute a heavy burden on healthcare expenditure due to their negative impact on clinical outcomes in patients. DM is highly prevalent in the Middle East. The Atrial fibrillation Better Care (ABC) pathway provides a simple step-by-step strategy with an integrated, holistic approach to AF management: A, Avoid stroke (Anticoagulation); B, Better symptom management; C, Cardiovascular and comorbidity risk management. Aim Evaluation of the AF treatment compliance to ABC pathway regimen in patients with DM based on a large real-world registry from the Middle East region. We assessed the impact of ABC-pathway compliance on all-cause mortality and the composite outcome of stroke or systemic embolism, all-cause death and cardiovascular hospitalizations. Methods From 2043 patients in the Gulf SAFE registry, 603 patients with DM were included in an analysis of compliance with components of the ABC pathway: A, oral anticoagulation (OAC) use in patients with CHA2DS2-VASc score ≥1 (≥2 in females); B, AF symptoms according to the European Heart Rhythm Association (EHRA) score; C, Optimized management of cardiovascular comorbidities e.g. blood pressure control, statins for vascular disease, etc. Results From 606 patients, 86 (14.3%) patients were treated in compliance with the ABC pathway. During 1-year follow-up, 207 composite outcome events and 87 deaths occurred. Mortality was significantly lower in the ABC-adherent group vs non-ABC compliant (5.8% vs 15.9%, p=0.0014, respectively) (Figure). On multivariate analysis, ABC-adherent management was associated with a lower risk of all-cause death and the composite outcome after 6 months (OR 0.18; 95% CI, 0.42–0.75 and OR 0.54; 95% Cl, 0.30–1.00, respectively) and at 1 year (OR 0.30; 95% Cl,0.11–0.76 and OR 0.57; 95% Cl, 0.33–0.97, respectively) vs the non-ABC group (Table). Conclusions Integrated AF care, according to ABC pathway, was independently associated with a lower risk of all-cause death and the composite outcome, in DM patients with AF. This highlights the importance of a comprehensive and holistic approach to AF management. Events rates and outcomes odds ratio Funding Acknowledgement Type of funding source: None

The Atrial Fibrillation Better Care pathway for managing atrial fibrillation: a review

“…The 12 included studies used data from seven different datasets. Three datasets were prospectively collected, 12 , 15–18 two were retrospective post hoc analyses of prospectively collected data 19 , 21 , 22 and two were registries or electronic health records. 13 , 14 , 20 , 23 Characteristics of the included studies are provided in Table 1 .…”

“… 13 , 14 , 20 , 23 Characteristics of the included studies are provided in Table 1 . Studies used data from around the world: South Korea ( n = 3), 13 , 14 , 23 China ( n = 2), 17 , 18 the Middle East ( n = 2), 15 , 16 Italy ( n = 1), 19 Europe ( n = 1), 20 the USA and Canada ( n = 2), 21 , 22 and the Balkans ( n = 1). 12 …”

“…Sample sizes varied from 603 in the Gulf Survey of Atrial Fibrillation Events (SAFE) Registry 15 to over 260 000 in the Korea National Health Insurance Service database. 13 Age varied considerably between studies, ranging from 56.7 16 to 73.1 years.…”

“…The follow-up times of six of the studies were relatively short, at only 1–2 years. 15–20 Only the studies based on the Korean Nation Health Insurance Service database 13 , 14 , 23 and the AFFIRM trial 21 , 22 followed up patients for >2 years. There was no significant difference between the results of studies with longer and shorter follow-up.…”

“…Atrial fibrillation was denoted differently, with some studies based on AF trial cohorts where patients had AF confirmed by >30 s AF in ECG or 24 h Holter, 15–18 while others relied on an AF diagnosis recorded in their electronic health records. 13 , 14 , 23 Seven studies 12–14 , 16 , 19 , 20 , 23 included all available AF patients within their cohorts, while some only included patients who were already high risk of stroke 21 , 22 with some requiring a CHA 2 DS 2 -VASc score ≥2 17 , 18 or for patients to have a specific comorbidity, such as diabetes mellitus.…”