Title : Adherence to Atrial Fibrillation Better Care (ABC) pathway management of rural atrial fibrillation patients in China: A cross-sectional study
Abstract:
Background: Atrial fibrillation (AF) is the most common heart rate disorder in adults. According to 2020 European Society of Cardiology (ESC) guidelines, the Atrial Fibrillation Better Care (ABC) pathway can effectively improve the integrated management of AF using a simple strategy: (A) Avoid stroke or anticoagulation, (B) Better symptom control using rate or rhythm control methods, and (C) Cardiovascular and comorbidity management. Rural AF patients have lower awareness of AF management compared to urban AF patients in China. Investigating adherence to ABC pathway management in rural patients is important to improve integrated management of AF. However, adherence to ABC pathway management among rural AF patients in China is unclear.
Aim: To investigated adherence to ABC pathway management and its associated factors among rural AF patients in China.
Methods: In this cross-sectional study, we recruited 870 AF patients from a rural area in China from August 2022 to January 2023. Adherence to ABC pathway management was defined based on the 2020 ESC guidelines. Demographic and clinic characteristics data were obtained, including comorbidities and concomitant treatment. Basic characteristics and adherence to ABC pathway management were evaluated by descriptive statistics. Univariate analysis was used to compare differences in adherence to ABC pathway management among different demographics and clinical characteristics. Multivariate logistic regression was performed to identify predictors of adherence to ABC pathway management.
Results: Among the 870 rural AF patients, 82.07% were ≥65 years of age, the male-female ratio was 1.025:1.000, 59.31% had a primary school or below, 53.10% had a monthly household income per capita <1000 RMB and 72.30% were diagnosed paroxysmal AF. Adherence to ABC pathway management was at a very low level (5.7%), with 30.3%, 60.0% and 17.2% adherence to A, B and C pathway management, respectively. In multivariate logistic regression analysis, adherence to ABC pathway management was significantly associated with: educational level [senior middle school or above compared with primary school or below, OR = 4.256, 95% CI: 1.094 – 16.551], monthly household income per capita [>3000 RMB and 1000 – 3000 RMB compared with <1000 RMB, OR = 4.180, 95% CI: 1.049 – 16.662 and OR = 4.809, 95% CI: 1.317 – 17.565, respectively], type of AF [persistent AF compared with paroxysmal AF, OR = 0.031, 95% CI: 0.003 – 0.281, respectively], CHA2DS2-VASc Score ≥2 (male)?Score≥3 (female) (OR = 0.023, 95% CI: 0.008 – 0.066 ), receive oral anticoagulation/ left atrial appendage closure (OR = 10.559, 95% CI: 3.676 – 30.333).
Conclusions: Adherence to ABC pathway management of rural AF patients in China was unsatisfactory, especially for A and C pathway. Further research is warranted to improve the integrated management of AF using targeted approaches according to the education level, income, AF type, CHA2DS2-VASc Score and anticoagulation strategies of rural AF patients in China.
Keywords: Atrial fibrillation, Atrial Fibrillation Better Care (ABC) pathway, integrated management, rural
Audience Take away Notes:
- Adherence to ABC pathway management of rural AF patients in China was extremely low, especially for A and C pathway. This suggested that improving adherence to ABC pathway management of rural AF patients in China should be an important direction for future research, and that A and C pathway should be focused on.
- AF patients with higher education and income and received oral anticoagulation/ left atrial appendage closure had better adherence to ABC pathway management.
- AF patients diagnosed persistent AF and with CHA2DS2-VASc Score ≥2 (male)?Score≥3 (female) have poorer adherence to ABC pathway management.
