Adherence to the ABC (Atrial fibrillation Better Care) pathway in the Balkan region: the BALKAN-AF survey

摘要

Introduction: The?Atrial fibrillation Better Care (ABC) pathway provides a?useful way of simplifying decision-making considerations in a?holistic approach to atrial fibrillation management. Objectives: To evaluate adherence to the?ABC pathway and to determine major gaps in adherence in patients in the?BALKAN-AF survey. Patients and methods: In this ancillary analysis, patients from the?BALKAN-AF survey were divided into the?following groups: A?(avoid stroke) +?B (better symptom control) +?C (cardiovascular and comorbidity risk management)-adherent and -nonadherent management. Results: Among 2712 enrolled patients, 1013 (43.8%) patients with mean (SD) age of 68.8 (10.2) years and mean CHA 2 DS 2 -VASc score of 3.4 (1.8) had A+B+C-adherent management and 1299 (56.2%) had A+B+C-nonadherent management. Independent predictors of increased A+B+C-adherent management were: capital city (odds ratio [OR], 1.23; 95% CI, 1.03–1.46; P = 0.02), treatment by cardiologist (OR, 1.34; 95% CI, 1.08–1.66; P = 0.01), hypertension (OR, 2.2; 95% CI, 1.74–2.77; P 0.001), diabetes mellitus (OR, 1.28; 95% CI, 1.05–1.57; P = 0.01), and multimorbidity (the presence of 2 or more long-term conditions) (OR, 1.85; 95% CI, 1.43–2.38; P 0.001). Independent predictors of decreased A+B+C-adherent management were: age 80 years or older (OR, 0.61; 95% CI, 0.48–0.76; P 0.001) and history of bleeding (OR, 0.5; 95% CI, 0.33–0.75; P = 0.001). Conclusions: Physicians’ adherence to integrated AF management based on the?ABC pathway was suboptimal. Addressing the?identified clinical and system-related factors associated with A+B+C-nonadherent management using targeted approaches is needed to optimize treatment of patients with AF in the?Balkan region.