Integrated Care Systems and the Aortovascular Hub

Key Points Question Is smoking cessation in patients with newly diagnosed atrial fibrillation (AF) associated with a lower risk of incident dementia? Findings In a cohort study of 126 252 patients with new-onset AF in South Korea, smoking cessation after an AF diagnosis was associated with a significantly lower risk of dementia than that of patients who were current smokers. Meaning These findings suggest that smoking cessation could be more proactively promoted in patients with newly diagnosed AF to reduce the burden of AF-related dementia.

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“…These findings support the increasing move toward holistic care for AF, stroke, and other cardiovascular diseases. 44 , 45 …”

Section: Discussionmentioning

confidence: 99%

Risk of Dementia After Smoking Cessation in Patients With Newly Diagnosed Atrial Fibrillation

Lee

Choi

et al. 2022

JAMA Netw Open

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“…The concept of integrated care was developed by Wagner et al ( 4 ) regarding the effective interventions for patients with chronic diseases highlighting five areas, namely, the use of evidence-based therapies with planned care of interventions, reorganization of health systems, improved patient self-management support, increased access to expertise with multidisciplinary teams, and greater availability of clinical information ( 3 , 4 ). Such an integrated care approach can be extended to various clinical settings ( 5 , 6 ). In the case of AF, such an integrated and holistic approach is essential.…”

Section: Introductionmentioning

confidence: 99%

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

Esteve‐Pastor

Ruiz‐Ortiz

Muñiz

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAn integrated and holistic approach is increasingly advocated in patients with atrial fibrillation (AF), based on the “Atrial fibrillation Better Care (ABC) pathway: A, Avoid stroke with anticoagulation; B, better symptom management; C, cardiovascular and comorbidity risk management.” The aim of this study was to examine the prevalence of adherence to each component of the ABC pathway and to analyze its impact on long-term prognosis in the “real-world” cohort of AF patients from the FANTASIIA registry.MethodsThis prospective study included consecutive AF outpatients anticoagulated with direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA) from June 2013 to October 2014. From the ABC pathway, adherence to the “A criterion” was defined by a time in the therapeutic range (TTR) ≥ 70% or correct dose with DOAC; “B criterion” adherence was defined by a European Heart Rhythm Association (EHRA) Symptom Scale I-II; and “C criterion” adherence was defined as optimized risk factors and comorbidity management. Baseline features and embolic events, severe bleeding, and all-cause and cardiovascular mortality rates up to 3 years of follow-up were analyzed, and a Cox multivariate analysis was performed to investigate the role of each component of the ABC pathway in predicting major events.ResultsA total of 1,955 AF patients (age: 74.4 ± 9.4 years; 43.2% female patients) were included in this study: adherence to A criterion was observed in 920 (47.1%) patients; adherence to B criterion was observed in 1,791 (91.6%) patients; and adherence to C criterion was observed in 682 (34.8%) patients. Only 394 (20.2%) of the whole population had good control of AF according to the 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 with non-adherence. Adherence to the 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 major adverse cardiovascular events (MACE) [HR: 0.41, 95%CI (0.28–0.62); p < 0.001] compared with non-adherence. AF patients with C criterion adherence had a 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 [HR: 0.64, 95%CI (0.42–0.99); p = 0.042].ConclusionIn real-world anticoagulated AF patients from FANTASIIA registry, we observed a lack of adherence to integrated care management of AF following the ABC pathway. AF managed according to the ABC pathway was associated with a significant reduction in adverse outcomes during long follow-up, suggesting the benefit of a holistic and integrated approach to AF management.

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“…46 Of note the integrated care approach can be applied to other clinical scenarios (e.g., stroke, aortovascular disease) given the need to manage the "whole" patient, and not just one aspect of the patient. 47,48 Before characterization and treatment of AF, it is important to detect the arrhythmia given the potential impact on clinical outcomes. 49,50 Indeed, even asymptomatic AF is not benign, as shown in a nice study of the risk of ischemic stroke in asymptomatic AF patients incidentally detected in primary care.…”

Section: Refining Anticoagulation Managementmentioning

confidence: 99%