Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Pharmacology (Antiarrhythmic drugs and anticoagulants)
D-PO02 - Poster Session II (ID 47)
Poster
D-PO02-233 - Effect Of Integrated Care Management In Frail Patients With Atrial Fibrillation: A Nationwide Cohort Study (ID 1073)
Abstract
Background: An integrated care approach might be of benefit for clinical outcomes of patients with atrial fibrillation (AF).
Objective: This study evaluated whether compliance with the Atrial fibrillation Better Care (ABC) pathway for integrated care management would improve population-based clinical outcomes amongst frail elderly AF patients.
Methods: From the Korea National Health Insurance Service database, 262,987 non-valvular AF patients were enrolled between 2005 and 2015. Using the aggregate score, patients were divided into three categories based on frailty: low, intermediate, and high frailty risk strata.
Results: Over a mean follow-up of 5.9 (IQR 3.2, 9.4) years, compared with Non-ABC group, the ABC group had lower event rates and risk of all-cause death and the composite outcome in the low and intermediate frailty risk groups. In high frailty risk patients, the ABC group had lower rates of all-cause death (6.5 vs. 17.5 per 100 person-years, p<0.001; HR 0.74; 95% CI 0.56-0.97) but was non-significant for the composite outcome (10.5 vs. 26.0 per 100 person-years, p=0.101; HR 0.79; 95% CI 0.59-1.05) compared with the Non-ABC group. When the 3 frailty categories were compared, the greatest benefit on mortality seen in the high frailty group (pint<0.001), but for the composite outcome, there was no statistical interaction for the 3 frailty categories (pint=0.063).
Conclusion: Compliance with the simple ABC pathway is associated with improved outcomes in AF patients with high frailty risk. Given the high healthcare burden associated with AF, such a streamlined holistic approach to AF management should be implemented, to improve outcomes in such patients.
Collapse
Objective: This study evaluated whether compliance with the Atrial fibrillation Better Care (ABC) pathway for integrated care management would improve population-based clinical outcomes amongst frail elderly AF patients.
Methods: From the Korea National Health Insurance Service database, 262,987 non-valvular AF patients were enrolled between 2005 and 2015. Using the aggregate score, patients were divided into three categories based on frailty: low, intermediate, and high frailty risk strata.
Results: Over a mean follow-up of 5.9 (IQR 3.2, 9.4) years, compared with Non-ABC group, the ABC group had lower event rates and risk of all-cause death and the composite outcome in the low and intermediate frailty risk groups. In high frailty risk patients, the ABC group had lower rates of all-cause death (6.5 vs. 17.5 per 100 person-years, p<0.001; HR 0.74; 95% CI 0.56-0.97) but was non-significant for the composite outcome (10.5 vs. 26.0 per 100 person-years, p=0.101; HR 0.79; 95% CI 0.59-1.05) compared with the Non-ABC group. When the 3 frailty categories were compared, the greatest benefit on mortality seen in the high frailty group (pint<0.001), but for the composite outcome, there was no statistical interaction for the 3 frailty categories (pint=0.063).
Conclusion: Compliance with the simple ABC pathway is associated with improved outcomes in AF patients with high frailty risk. Given the high healthcare burden associated with AF, such a streamlined holistic approach to AF management should be implemented, to improve outcomes in such patients.
