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Adherence to the Atrial fibrillation Better Care pathway and the risk of adverse health outcomes in older care home residents with atrial fibrillation: a retrospective data linkage study 2003–18
Leona A Ritchie 
,
Stephanie L Harrison ,
Peter E Penson ,
Ashley Akbari ,
Fatemeh Torabi ,
Joe Hollinghurst,
Daniel Harris,
Oluwakayode B Oke,
Asangaedem Akpan,
Julian Halcox ,
Sarah E Rodgers,
Gregory Y H Lip,
Deirdre A Lane
,
Stephanie L Harrison ,
Peter E Penson ,
Ashley Akbari ,
Fatemeh Torabi ,
Joe Hollinghurst,
Daniel Harris,
Oluwakayode B Oke,
Asangaedem Akpan,
Julian Halcox ,
Sarah E Rodgers,
Gregory Y H Lip,
Deirdre A Lane
Age and Ageing, Volume: 53, Issue: 2
Swansea University Authors:
Ashley Akbari , Fatemeh Torabi , Joe Hollinghurst, Daniel Harris, Julian Halcox
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DOI (Published version): 10.1093/ageing/afae021
Abstract
BackgroundThe Atrial fibrillation Better Care (ABC) pathway is the gold-standard approach to atrial fibrillation (AF) management, but the effect of implementation on health outcomes in care home residents is unknown.ObjectiveTo examine associations between ABC pathway adherence and stroke, transient...
| Published in: | Age and Ageing |
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| ISSN: | 0002-0729 1468-2834 |
| Published: |
Oxford University Press (OUP)
2024
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| Online Access: |
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa65727 |
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| Abstract: |
BackgroundThe Atrial fibrillation Better Care (ABC) pathway is the gold-standard approach to atrial fibrillation (AF) management, but the effect of implementation on health outcomes in care home residents is unknown.ObjectiveTo examine associations between ABC pathway adherence and stroke, transient ischaemic attack, cardiovascular hospitalisation, major bleeding, mortality and a composite of all these outcomes in care home residents.MethodsA retrospective cohort study of older care home residents (≥65 years) in Wales with AF was conducted between 1 January 2003 and 31 December 2018 using the Secure Anonymised Information Linkage Databank. Adherence to the ABC pathway was assessed at care home entry using pre-specified definitions. Cox proportional hazard and competing risk models were used to estimate the risk of health outcomes according to ABC adherence.ResultsFrom 14,493 residents (median [interquartile range] age 87.0 [82.6–91.2] years, 35.2% male) with AF, 5,531 (38.2%) were ABC pathway adherent. Pathway adherence was not significantly associated with risk of the composite outcome (adjusted hazard ratio, 95% confidence interval [CI]: 1.01 [0.97–1.05]). There was a significant independent association observed between ABC pathway adherence and a reduced risk of myocardial infarction (0.70 [0.50–0.98]), but a higher risk of haemorrhagic stroke (1.59 [1.06–2.39]). ABC pathway adherence was not significantly associated with any other individual health outcomes examined.ConclusionAn ABC adherent approach in care home residents was not consistently associated with improved health outcomes. Findings should be interpreted with caution owing to difficulties in defining pathway adherence using routinely collected data and an individualised approach is recommended. |
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| Keywords: |
atrial fibrillation, care homes, health outcomes, older people, integrated care |
| College: |
Faculty of Medicine, Health and Life Sciences |
| Funders: |
No specific funding was received for this work. This work was supported by Health Data Research UK [HDR-9006], which receives its funding from the UK Medical Research Council; Engineering and Physical Sciences Research Council; Economic and Social Research Council; Department of Health and Social Care (England); Chief Scientist Office of the Scottish Government Health and Social Care Directorates; Health and Social Care Research and Development Division (Welsh Government); Public Health Agency (Northern Ireland); British Heart Foundation (BHF) and the Wellcome Trust and Administrative Data Research UK, which is funded by the Economic and Social Research Council [grant ES/S007393/1]. SER is part-funded by the National Institute for Health Research (NIHR) Applied Research Collaboration North West Coast (ARC NWC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. |
| Issue: |
2 |