Improved Population-Based Clinical Outcomes of Patients with Atrial Fibrillation by Compliance with the Simple ABC (Atrial Fibrillation Better Care) Pathway for Integrated Care Management: A Nationwide Cohort Study

Minjae Yoon, Pil Sung Yang, Eunsun Jang, Hee Tae Yu, Tae Hoon Kim, Jae Sun Uhm, Jong Youn Kim, Jung Hoon Sung, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung, Gregory Y.H. Lip

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background An integrated care approach might be of benefit for clinical outcomes of patients with atrial fibrillation (AF). This study evaluated whether compliance with the Atrial fibrillation Better Care (ABC) pathway for integrated care management (A Avoid stroke; B Better symptom management; C Cardiovascular risk and Comorbidity optimization) would improve population-based clinical outcomes in a nationwide AF cohort. Methods and Results From the Korea National Health Insurance Service database, a total of 204,842 nonvalvular AF patients were enrolled between January 1, 2005 and December 31, 2015. Patients that fulfilled all criteria of the ABC pathway were defined as the ABC group, and those who did not were the Non-ABC group. Over a mean follow-up of 6.2 ± 3.5 years, the ABC pathway compliant group had lower rates of all-cause death (0.80 vs. 2.72 per 100 person-years, p < 0.001) and the composite outcome of death, ischemic stroke, major bleeding, and myocardial infarction (2.34 vs. 5.92 per 100 person-years, p < 0.001) compared with the Non-ABC compliant group. Adjusted Cox multivariable regression showed that the ABC group had a significantly lower risk of all-cause death (adjusted hazard ratio [HR] 0.82; 95% confidence interval [CI], 0.78-0.86) and the composite outcome (adjusted HR 0.86; 95% CI, 0.83-0.89). With the increasing numbers of ABC pathway criteria fulfilled, the risk of all-cause death and composite outcome were progressively lowered. Conclusion In the first study of a nationwide population cohort, we show that compliance with the simple ABC pathway is associated with improved clinically relevant outcomes of patients with AF. Given the high health care burden associated with AF, such a streamlined holistic approach to AF management should be implemented, to improve the care of such patients.

Original languageEnglish
Pages (from-to)1695-1703
Number of pages9
JournalThrombosis and Haemostasis
Volume19
Issue number10
DOIs
Publication statusPublished - 2019 Jan 1

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Atrial Fibrillation
Cohort Studies
Population
Cause of Death
National Health Programs
Stroke
Confidence Intervals
Korea
Comorbidity
Patient Care
Myocardial Infarction
Databases
Hemorrhage
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

Yoon, Minjae ; Yang, Pil Sung ; Jang, Eunsun ; Yu, Hee Tae ; Kim, Tae Hoon ; Uhm, Jae Sun ; Kim, Jong Youn ; Sung, Jung Hoon ; Pak, Hui Nam ; Lee, Moon Hyoung ; Joung, Boyoung ; Lip, Gregory Y.H. / Improved Population-Based Clinical Outcomes of Patients with Atrial Fibrillation by Compliance with the Simple ABC (Atrial Fibrillation Better Care) Pathway for Integrated Care Management : A Nationwide Cohort Study. In: Thrombosis and Haemostasis. 2019 ; Vol. 19, No. 10. pp. 1695-1703.
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abstract = "Background An integrated care approach might be of benefit for clinical outcomes of patients with atrial fibrillation (AF). This study evaluated whether compliance with the Atrial fibrillation Better Care (ABC) pathway for integrated care management (A Avoid stroke; B Better symptom management; C Cardiovascular risk and Comorbidity optimization) would improve population-based clinical outcomes in a nationwide AF cohort. Methods and Results From the Korea National Health Insurance Service database, a total of 204,842 nonvalvular AF patients were enrolled between January 1, 2005 and December 31, 2015. Patients that fulfilled all criteria of the ABC pathway were defined as the ABC group, and those who did not were the Non-ABC group. Over a mean follow-up of 6.2 ± 3.5 years, the ABC pathway compliant group had lower rates of all-cause death (0.80 vs. 2.72 per 100 person-years, p < 0.001) and the composite outcome of death, ischemic stroke, major bleeding, and myocardial infarction (2.34 vs. 5.92 per 100 person-years, p < 0.001) compared with the Non-ABC compliant group. Adjusted Cox multivariable regression showed that the ABC group had a significantly lower risk of all-cause death (adjusted hazard ratio [HR] 0.82; 95{\%} confidence interval [CI], 0.78-0.86) and the composite outcome (adjusted HR 0.86; 95{\%} CI, 0.83-0.89). With the increasing numbers of ABC pathway criteria fulfilled, the risk of all-cause death and composite outcome were progressively lowered. Conclusion In the first study of a nationwide population cohort, we show that compliance with the simple ABC pathway is associated with improved clinically relevant outcomes of patients with AF. Given the high health care burden associated with AF, such a streamlined holistic approach to AF management should be implemented, to improve the care of such patients.",
author = "Minjae Yoon and Yang, {Pil Sung} and Eunsun Jang and Yu, {Hee Tae} and Kim, {Tae Hoon} and Uhm, {Jae Sun} and Kim, {Jong Youn} and Sung, {Jung Hoon} and Pak, {Hui Nam} and Lee, {Moon Hyoung} and Boyoung Joung and Lip, {Gregory Y.H.}",
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Improved Population-Based Clinical Outcomes of Patients with Atrial Fibrillation by Compliance with the Simple ABC (Atrial Fibrillation Better Care) Pathway for Integrated Care Management : A Nationwide Cohort Study. / Yoon, Minjae; Yang, Pil Sung; Jang, Eunsun; Yu, Hee Tae; Kim, Tae Hoon; Uhm, Jae Sun; Kim, Jong Youn; Sung, Jung Hoon; Pak, Hui Nam; Lee, Moon Hyoung; Joung, Boyoung; Lip, Gregory Y.H.

In: Thrombosis and Haemostasis, Vol. 19, No. 10, 01.01.2019, p. 1695-1703.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Improved Population-Based Clinical Outcomes of Patients with Atrial Fibrillation by Compliance with the Simple ABC (Atrial Fibrillation Better Care) Pathway for Integrated Care Management

T2 - A Nationwide Cohort Study

AU - Yoon, Minjae

AU - Yang, Pil Sung

AU - Jang, Eunsun

AU - Yu, Hee Tae

AU - Kim, Tae Hoon

AU - Uhm, Jae Sun

AU - Kim, Jong Youn

AU - Sung, Jung Hoon

AU - Pak, Hui Nam

AU - Lee, Moon Hyoung

AU - Joung, Boyoung

AU - Lip, Gregory Y.H.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background An integrated care approach might be of benefit for clinical outcomes of patients with atrial fibrillation (AF). This study evaluated whether compliance with the Atrial fibrillation Better Care (ABC) pathway for integrated care management (A Avoid stroke; B Better symptom management; C Cardiovascular risk and Comorbidity optimization) would improve population-based clinical outcomes in a nationwide AF cohort. Methods and Results From the Korea National Health Insurance Service database, a total of 204,842 nonvalvular AF patients were enrolled between January 1, 2005 and December 31, 2015. Patients that fulfilled all criteria of the ABC pathway were defined as the ABC group, and those who did not were the Non-ABC group. Over a mean follow-up of 6.2 ± 3.5 years, the ABC pathway compliant group had lower rates of all-cause death (0.80 vs. 2.72 per 100 person-years, p < 0.001) and the composite outcome of death, ischemic stroke, major bleeding, and myocardial infarction (2.34 vs. 5.92 per 100 person-years, p < 0.001) compared with the Non-ABC compliant group. Adjusted Cox multivariable regression showed that the ABC group had a significantly lower risk of all-cause death (adjusted hazard ratio [HR] 0.82; 95% confidence interval [CI], 0.78-0.86) and the composite outcome (adjusted HR 0.86; 95% CI, 0.83-0.89). With the increasing numbers of ABC pathway criteria fulfilled, the risk of all-cause death and composite outcome were progressively lowered. Conclusion In the first study of a nationwide population cohort, we show that compliance with the simple ABC pathway is associated with improved clinically relevant outcomes of patients with AF. Given the high health care burden associated with AF, such a streamlined holistic approach to AF management should be implemented, to improve the care of such patients.

AB - Background An integrated care approach might be of benefit for clinical outcomes of patients with atrial fibrillation (AF). This study evaluated whether compliance with the Atrial fibrillation Better Care (ABC) pathway for integrated care management (A Avoid stroke; B Better symptom management; C Cardiovascular risk and Comorbidity optimization) would improve population-based clinical outcomes in a nationwide AF cohort. Methods and Results From the Korea National Health Insurance Service database, a total of 204,842 nonvalvular AF patients were enrolled between January 1, 2005 and December 31, 2015. Patients that fulfilled all criteria of the ABC pathway were defined as the ABC group, and those who did not were the Non-ABC group. Over a mean follow-up of 6.2 ± 3.5 years, the ABC pathway compliant group had lower rates of all-cause death (0.80 vs. 2.72 per 100 person-years, p < 0.001) and the composite outcome of death, ischemic stroke, major bleeding, and myocardial infarction (2.34 vs. 5.92 per 100 person-years, p < 0.001) compared with the Non-ABC compliant group. Adjusted Cox multivariable regression showed that the ABC group had a significantly lower risk of all-cause death (adjusted hazard ratio [HR] 0.82; 95% confidence interval [CI], 0.78-0.86) and the composite outcome (adjusted HR 0.86; 95% CI, 0.83-0.89). With the increasing numbers of ABC pathway criteria fulfilled, the risk of all-cause death and composite outcome were progressively lowered. Conclusion In the first study of a nationwide population cohort, we show that compliance with the simple ABC pathway is associated with improved clinically relevant outcomes of patients with AF. Given the high health care burden associated with AF, such a streamlined holistic approach to AF management should be implemented, to improve the care of such patients.

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