Adherence to the ABC (Atrial fibrillation Better Care) Pathway in the Balkan region: the BALKAN-AF Survey.
INTRODUCTION The Atrial fibrillation Better Care (ABC) pathway provides a useful way of simplifying decision-making considerations in a holistic approach to atrial fibrillation management. OBJECTIVES To evaluate adherence to ABC pathway and to determine major gaps in adherence to ABC pathway in patients in BALKAN-AF survey. PATIENTS AND METHODS In this ancillary analysis, patients in BALKAN-AF survey were divided into groups: "A (Avoid stroke)+B (Better symptom control)+C (Cardiovascular and comorbidity risk management)"-adherent and non-adherent "A+B+C" management. Results: Of 2,712 enrolled patients, 1,013 (43.8%) patients with mean (SD) age of 68.8 (10.2) years and mean CHA2DS2-VASc score of 3.4 (1.8) had "A+B+C"-adherent management and 1,299 (56.2%) had non-adherent-"A+B+C" management. Independent predictors of increased "A+B+C"-adherent management were: capital city [odds ratio (OR) 1.23, 95% confidence interval (CI) 1.03-1.46, p = 0.02], treatment by cardiologist (OR 1.34, 95% CI 1.08-1.66, p = 0.01), hypertension (OR 2.20, 95% CI 1.74-2.77, p <0.001), diabetes mellitus (OR 1.28, 95% CI 1.05-1.57, p = 0.01) and multimorbidity (the presence of two or more long-term conditions) (OR 1.85, 95% CI 1.43-2.38, p <0.001). Independent predictors of decreased "A+B+C"-adherent management were: age ≥80 years (OR 0.61, 95% CI 0.48-0.76, p < 0.001) and history of bleeding (OR 0.50, 95% CI 0.33-0.75, p = 0.001). CONCLUSIONS Physicians' adherence to integrated AF management based on the ABC pathway was suboptimal in our study. Addressing the identified clinical and system-related factors associated with non-adherent-"A+B+C" management using targeted approaches is needed to optimize treatment of AF patients in the Balkan region.