Evidence map›Paper›PMID 36056426›Full record

ArticleBMC medicine2022

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry.

Giulio Francesco Romiti, Marco Proietti, Marco Vitolo, Niccolò Bonini, Ameenathul Mazaya Fawzy, Wern Yew Ding, Laurent Fauchier, Francisco Marin, Michael Nabauer, Gheorghe Andrei Dan and 4 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
48citing papers in PubMed, 1 pooled it
10.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

48 citing papers in PubMed, 1 synthesis or guideline pooled it, 66 citations in OpenAlex.

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  16. Clinical complexity in patients with atrial fibrillation: exploring differential risk profiles from European and Asian cohorts.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 8 institutions in 8 countries.

Giulio Francesco Romiti *Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 West Derby St, Liverpool, L7 8TX, UK.
Marco Proietti *Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 West Derby St, Liverpool, L7 8TX, UK.
Marco VitoloLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 West Derby St, Liverpool, L7 8TX, UK.
Niccolò BoniniLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 West Derby St, Liverpool, L7 8TX, UK.
Ameenathul Mazaya FawzyLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 West Derby St, Liverpool, L7 8TX, UK.
Wern Yew DingLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 West Derby St, Liverpool, L7 8TX, UK.
Laurent FauchierService de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France.
Francisco MarinDepartment of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain.
Michael NabauerDepartment of Cardiology, Ludwig-Maximilians-University, Munich, Germany.
Gheorghe Andrei DanUniversity of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania.
Tatjana S PotparaSchool of Medicine, University of Belgrade, Belgrade, Serbia.
Giuseppe Boriani *Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
Gregory Y H Lip *Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 West Derby St, Liverpool, L7 8TX, UK. gregory.lip@liverpool.ac.uk.ORCID 0000-0002-7566-1626
ESC-EHRA EORP-AF General Long-Term Registry Investigators
Aalborg University · DKUniversity of Belgrade · RSLudwig-Maximilians-Universität München · DECarol Davila University of Medicine and Pharmacy · ROUniversity of Modena and Reggio Emilia · ITUniversity of Liverpool · GBHospital Universitario Virgen de la Arrixaca · ESCentre Hospitalier Universitaire de Tours · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundClinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The 'Atrial fibrillation Better Care' (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients.

methodsFrom the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses.

resultsAmong 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58-0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52-0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58-0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56-0.98) and composite outcome (aHR: 0.76, 95%CI 0.60-0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome.

conclusionsAn ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients.

Indexed as

Atrial FibrillationStrokeAnticoagulantsHumansRegistriesRisk FactorsAnticoagulantsAtrial fibrillationClinical complexityIntegrated managementOutcomes

Identifiers

PMID36056426
PMCPMC9440492
OpenAlexW4294266287

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.