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Background  For patients with atrial fibrillation, a comprehensive care approach based on the Atrial fibrillation Better Care ( ABC ) pathway can reduce the occurrence of adverse outcomes. The aim of this paper was to investigate if an approach based on the  ABC  pathway is associated with a reduced risk of adverse events in “clinically complex” atrial fibrillation patients, including those with multiple comorbidities, polypharmacy, and prior hospitalizations.    Methods and Results  We performed a post hoc analysis of the AFFIRM (Atrial Fibrillation Follow‐up Investigation of Rhythm Management) trial. The principal outcome was the composite of all‐cause hospitalization and all‐cause death. An integrated care approach ( ABC  group) was used in 3.8% of the multimorbidity group, 4.0% of the polypharmacy group, and 4.8%, of the hospitalized groups. In all “clinically complex” groups, the cumulative risk of the composite outcome was significantly lower in patients managed consistent with the  ABC  pathway versus non‐ ABC  pathway‐adherent (all  P <0.05). Cox regression analysis showed a reduction of composite outcomes in  ABC  pathway‐adherent versus non‐ ABC  pathway‐adherent for multimorbidity (hazard ratio [ HR ], 0.61, 95% CI, 0.44–0.85), polypharmacy ( HR , 0.68, 95%  CI , 0.47–1.00), and hospitalization ( HR , 0.59, 95%  CI , 0.42–0.85) groups. Secondary analyses showed that the higher number of  ABC  criteria fulfilled the larger associated reduction in relative risk, even for secondary outcomes considered.    Conclusions  Use of an  ABC  consistent pathway is associated with fewer major adverse events in patients with atrial fibrillation who have multiple comorbidities, use of polypharmacy, and prior hospitalization.

journal of the american heart association. cardiovascular and cerebrovascular disease

Comprehensive Management With the ABC (Atrial Fibrillation Better Care) Pathway in Clinically Complex Patients With Atrial Fibrillation: A Post Hoc Ancillary Analysis From the AFFIRM Trial