In the prospective GLORIA-AF registry of AF patients, the presence of clinical complexity was associated with lower odds of being prescribed with OAC (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.44–0.57), higher OAC discontinuation, and with a higher risk of adverse events (hazard ratio [HR] 1.63, 95% CI 1.43–1.86).[ 4 ] Indeed, “high clinical complexity” patients defined using latent class analysis constituted 6.6% of AF patients, and was associated with higher hazards of experiencing the primary composite outcome of all-cause death and major adverse cardiovascular events (HR 1.47, 95% 1.24–1.75).[ 5 ] Comorbidities and polypharmacy have an important influence on decision-making, by conditioning either lack of prescription of OAC in patients at risk or inappropriate dosing.[ 6 ] [ 7 ] [ 8 ] Recognizing that AF management is more than simply OAC alone, and requires a holistic and integrated care approach, contemporary guidelines globally on AF management have promoted this concept, based on the Atrial fibrillation Better Care (ABC) pathway, emphasizing Anticoagulation, Better symptom management with rate or rhythm control, and Comorbidity/lifestyle management.[ 9 ] [ 10 ] [ 11 ] The ABC pathway is well supported by clinical trial and real-world evidence,[ 11 ] whereby adherence to the ABC pathway is associated with a reduction in all-cause and cardiovascular mortality, stroke, and bleeding.[ 12 ] [ 13 ] Despite this, adherence to ABC-based management remains low, whereby a meta-analysis of 14 studies revealed that only 21% (95% CI 13–34%) of AF patients were managed in accordance with the ABC pathway.[ 12 ] This perhaps highlights a critical gap in the implementation of comprehensive evidence-based care strategies. 2 key findings →
Design: meta-analysis Evidence: high
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