Adherence to the ABC (atrial fibrillation better care) pathway and risk of adverse outcomes in patients with chronic kidney disease: a report from the prospective APHRS-AF registryResearch in context

Adherence to the ABC (atrial fibrillation better care) pathway and risk of adverse outcomes in patients with chronic kidney disease: a report from the prospective APHRS-AF registryResearch in context

Summary: Background: Limited data exist on the effectiveness of the ABC (Atrial Fibrillation Better Care) pathway in reducing adverse events in Asian patients with atrial fibrillation (AF) and chronic kidney disease (CKD). Methods: A post-hoc analysis of the prospective APHRS AF Registry. Patients...

Full description

Saved in:
Bibliographic Details
Main Authors: Tommaso Bucci, Katarzyna Nabradalik, Krysztof Irlik, Alena Shantsila, Giulio Francesco Romiti, Marco Proietti, Wee-Siong Teo, Hyung-Wook Park, Wataru Shimizu, Hung-Fat Tse, Tze-Fan Chao, Gregory Y.H. Lip, Chun-Wah David Siu, Kenji Yodogawa, Hiroyuki Tsutsui, Yasushi Mukai, Hirofumi Tomita, Daisuke Horiuchi, Joji Hagii, Kazutaka Aonuma, Yasuo Okumura, Masahiko Goya, Kenzo Hirao, Ajioka Masayoshi, Nobuhisa Hagiwara, Atsushi Suzuki, Teiichi Yamane, Takanori Ikeda, Hitomi Yuzawa, Kazuhiro Satomi, Yoshinao Yazaki, Keiichi Fukuda, Yoshinori Kobayashi, Norishige Morita, Toyoaki Murohara, Eiichi Watanabe, Masahide Harada, Satoru Sakagami, Takahiro Saeki, Kengo Kusano, Koji Miyamoto, Shinsuke Miyazaki, Hiroshi Tada, Koichi Inoue, Nobuaki Tanaka, Yukihiro Koretsune, Haruhiko Abe, Yasuki Kihara, Yukiko Nakano, Akihiko Shimizu, Yasuhiro Yoshiga, Tomohiro Sakamoto, Ken Okumura, Naohiko Takahashi, Tetsuji Shinohara, Kyoko Soejima, Masahiko Takagi, Mitsuharu Kawamura, Yumi Munetsugu, Jae-Min Shim, Jae Sun Uhm, Sung Il Im, Hyoung-Seob Par, Jun Hyung Kim, Young Keun On, Il-Young Oh, Seung Yong Shin, Jum Suk Ko, Jun Beom Park, Kelvin Cheok-Keng Wong, Toon-Wei Lim, David Foo, Shih-Ann Chen, YennJiang Lin, Fa-Po Chung, Yu-Feng Hu, Shil-Lin Chang, Ta-Chuan Tuan, Jo-Nan Liao, Cheng-Hung Li, Jin-Long Huang, Yu-Cheng Hsieh, Tsu-Juey Wu, Ying-Chieh Liao, Cheng-Hung Chiang, Hsiang-Chiang Hsiao, Tung-Chen Yeh, Wei-Siang Lin, Wen-Yu Lin, Jen-Yuan Kuo, Chong-Lie Hong, Yih-Je Wu, Ying-Siang Li, Jui-Peng Tsai, Kuo-Tzu Sung, Sheng-Hsiung Chang
Format: Article
Language:English
Published: Elsevier 2025-05-01
Series:The Lancet Regional Health. Western Pacific
Subjects:
Atrial fibrillation
Cardiovascular events
Chronic kidney disease
ABC pathway
Online Access:http://www.sciencedirect.com/science/article/pii/S2666606525001075
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Summary: Background: Limited data exist on the effectiveness of the ABC (Atrial Fibrillation Better Care) pathway in reducing adverse events in Asian patients with atrial fibrillation (AF) and chronic kidney disease (CKD). Methods: A post-hoc analysis of the prospective APHRS AF Registry. Patients were divided into CKD (eGFR < 60 ml/min) and non-CKD (eGFR ≥ 60 ml/min) groups. Logistic regression assessed factors associated with CKD, oral anticoagulant (OAC) use, and rhythm control strategies. Cox regression estimated hazard ratios (HRs) for a composite outcome of all-cause mortality and major adverse cardiovascular events. Subgroup analyses evaluated outcomes by CKD severity and ABC adherence. Findings: Of 3550 patients, 1029 had CKD (mean age 75.3 ± 10.3 years, 40.3% female), and 2521 did not (66.4 ± 11.3 years, 32.3% female). CKD patients were older, more often female, had lower ABC adherence (29.5% vs. 42.1%, p < 0.001) and anticoagulation use (Odds Ratio [OR] 0.77, 95% CI 0.61–0.96), but higher warfarin use, and were less likely to receive rhythm control (OR 0.79, 95% CI 0.66–0.94) comparing to those without CKD. CKD and adherence to the ABC pathway were independently associated with higher (HR 1.90, 95% CI 1.46–2.48) and lower (HR 0.64, 95% CI 0.48–0.87) risks of the composite outcome, respectively. Adverse event risks increased with CKD severity, and ABC pathway benefits were observed irrespective of CKD. Interpretation: AF patients with CKD show lower ABC pathway adherence and high risk of adverse events. Improving adherence to integrated care approaches may improve prognosis in this patient group. Funding: This study was an independent research grant by Pfizer and Bristol Myers Squibb (BMS) to APHRS.
ISSN:2666-6065

Similar Items