Effects of the ABC pathway on clinical outcomes in very elderly Chinese patients with atrial fibrillation. A report from the optimal thromboprophylaxis in elderly Chinese patients with atrial fibrillation (ChiOTEAF) registry

The current Atrial fibrillation Better Care (ABC) pathway for holistic or integrated management of AF is associated with improved clinical outcomes; however, data on the very elderly (aged ≥ 85 years) are sparse.To evaluate the impact of ABC pathway on clinical outcomes amongst very elderly AF patients over a follow-up period of 1 year.The ChiOTEAF registry is a prospective, multicenter nationwide study conducted from October 2014 to December 2018. Endpoints of interest were the composite outcome of all-cause death/any thromboembolism (TE), all-cause death, TE events, and major bleeding.The eligible cohort included 1215 individuals (mean age 88.5 ± 3.3; 33.5% female), of which 142 (11.7%) were managed accordingly to the ABC pathway. ABC compliance was independently associated with lower odds of the composite outcome (odds Ratio (OR): 0.23; 95% confidence interval (CI): 0.08-0.66) and all-cause death (OR: 0.22; 95% CI: 0.07-0.75), without a significant increase in major bleeding compared to ABC non-compliance. Health-related quality of life (QOL) was also significantly higher in the ABC compliant group compared to the non-compliant group (EQ score 0.83 ± 0.17 vs. 0.78 ± 0.20; p = 0.004). Independent predictors of ABC non-compliance were prior major bleeding, chronic kidney disease, and dementia.Our findings suggest that adherence to the ABC pathway in very elderly patients is associated with significantly improved survival and health-related QOL.