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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 Orcid Logo, Stephanie L Harrison Orcid Logo, Peter E Penson Orcid Logo, Ashley Akbari Orcid Logo, Fatemeh Torabi Orcid Logo, Joe Hollinghurst, Daniel Harris, Oluwakayode B Oke, Asangaedem Akpan, Julian Halcox Orcid Logo, Sarah E Rodgers, Gregory Y H Lip, Deirdre A Lane

Age and Ageing, Volume: 53, Issue: 2

Swansea University Authors: Ashley Akbari Orcid Logo, Fatemeh Torabi Orcid Logo, Joe Hollinghurst, Daniel Harris, Julian Halcox Orcid Logo

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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...

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Published in: Age and Ageing
ISSN: 0002-0729 1468-2834
Published: Oxford University Press (OUP) 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa65727
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fullrecord <?xml version="1.0" encoding="utf-8"?><rfc1807 xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema"><bib-version>v2</bib-version><id>65727</id><entry>2024-03-01</entry><title>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</title><swanseaauthors><author><sid>aa1b025ec0243f708bb5eb0a93d6fb52</sid><ORCID>0000-0003-0814-0801</ORCID><firstname>Ashley</firstname><surname>Akbari</surname><name>Ashley Akbari</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>f569591e1bfb0e405b8091f99fec45d3</sid><ORCID>0000-0002-5853-4625</ORCID><firstname>Fatemeh</firstname><surname>Torabi</surname><name>Fatemeh Torabi</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>d7c51b69270b644a11b904629fe56ab0</sid><firstname>Joe</firstname><surname>Hollinghurst</surname><name>Joe Hollinghurst</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>e60c9c73b645f0e8033ae26fa8e634b8</sid><firstname>Daniel</firstname><surname>Harris</surname><name>Daniel Harris</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>3676f695eeda169d0f8c618adf27c04b</sid><ORCID>0000-0001-6926-2947</ORCID><firstname>Julian</firstname><surname>Halcox</surname><name>Julian Halcox</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2024-03-01</date><deptcode>HDAT</deptcode><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.</abstract><type>Journal Article</type><journal>Age and Ageing</journal><volume>53</volume><journalNumber>2</journalNumber><paginationStart/><paginationEnd/><publisher>Oxford University Press (OUP)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0002-0729</issnPrint><issnElectronic>1468-2834</issnElectronic><keywords>atrial fibrillation, care homes, health outcomes, older people, integrated care</keywords><publishedDay>22</publishedDay><publishedMonth>2</publishedMonth><publishedYear>2024</publishedYear><publishedDate>2024-02-22</publishedDate><doi>10.1093/ageing/afae021</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><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.</funders><projectreference/><lastEdited>2024-04-25T21:46:46.9418708</lastEdited><Created>2024-03-01T20:06:04.8792010</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Leona A</firstname><surname>Ritchie</surname><orcid>0000-0002-0392-1767</orcid><order>1</order></author><author><firstname>Stephanie L</firstname><surname>Harrison</surname><orcid>0000-0002-8846-0946</orcid><order>2</order></author><author><firstname>Peter E</firstname><surname>Penson</surname><orcid>0000-0001-6763-1489</orcid><order>3</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>4</order></author><author><firstname>Fatemeh</firstname><surname>Torabi</surname><orcid>0000-0002-5853-4625</orcid><order>5</order></author><author><firstname>Joe</firstname><surname>Hollinghurst</surname><order>6</order></author><author><firstname>Daniel</firstname><surname>Harris</surname><order>7</order></author><author><firstname>Oluwakayode B</firstname><surname>Oke</surname><order>8</order></author><author><firstname>Asangaedem</firstname><surname>Akpan</surname><order>9</order></author><author><firstname>Julian</firstname><surname>Halcox</surname><orcid>0000-0001-6926-2947</orcid><order>10</order></author><author><firstname>Sarah E</firstname><surname>Rodgers</surname><order>11</order></author><author><firstname>Gregory Y H</firstname><surname>Lip</surname><order>12</order></author><author><firstname>Deirdre A</firstname><surname>Lane</surname><order>13</order></author></authors><documents><document><filename>65727__29630__155f3206b6f2402c8fe914e3bf037996.pdf</filename><originalFilename>65727.pdf</originalFilename><uploaded>2024-03-05T10:19:35.6914207</uploaded><type>Output</type><contentLength>1081289</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>This is an Open Access ar ticle distributed under the terms of the Creative Commons Attribution License.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>https://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling v2 65727 2024-03-01 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 aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false f569591e1bfb0e405b8091f99fec45d3 0000-0002-5853-4625 Fatemeh Torabi Fatemeh Torabi true false d7c51b69270b644a11b904629fe56ab0 Joe Hollinghurst Joe Hollinghurst true false e60c9c73b645f0e8033ae26fa8e634b8 Daniel Harris Daniel Harris true false 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false 2024-03-01 HDAT 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. Journal Article Age and Ageing 53 2 Oxford University Press (OUP) 0002-0729 1468-2834 atrial fibrillation, care homes, health outcomes, older people, integrated care 22 2 2024 2024-02-22 10.1093/ageing/afae021 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University Another institution paid the OA fee 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. 2024-04-25T21:46:46.9418708 2024-03-01T20:06:04.8792010 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Leona A Ritchie 0000-0002-0392-1767 1 Stephanie L Harrison 0000-0002-8846-0946 2 Peter E Penson 0000-0001-6763-1489 3 Ashley Akbari 0000-0003-0814-0801 4 Fatemeh Torabi 0000-0002-5853-4625 5 Joe Hollinghurst 6 Daniel Harris 7 Oluwakayode B Oke 8 Asangaedem Akpan 9 Julian Halcox 0000-0001-6926-2947 10 Sarah E Rodgers 11 Gregory Y H Lip 12 Deirdre A Lane 13 65727__29630__155f3206b6f2402c8fe914e3bf037996.pdf 65727.pdf 2024-03-05T10:19:35.6914207 Output 1081289 application/pdf Version of Record true This is an Open Access ar ticle distributed under the terms of the Creative Commons Attribution License. true eng https://creativecommons.org/licenses/by/4.0/
title 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
spellingShingle 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
Ashley Akbari
Fatemeh Torabi
Joe Hollinghurst
Daniel Harris
Julian Halcox
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
author_id_str_mv aa1b025ec0243f708bb5eb0a93d6fb52
f569591e1bfb0e405b8091f99fec45d3
d7c51b69270b644a11b904629fe56ab0
e60c9c73b645f0e8033ae26fa8e634b8
3676f695eeda169d0f8c618adf27c04b
author_id_fullname_str_mv aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
f569591e1bfb0e405b8091f99fec45d3_***_Fatemeh Torabi
d7c51b69270b644a11b904629fe56ab0_***_Joe Hollinghurst
e60c9c73b645f0e8033ae26fa8e634b8_***_Daniel Harris
3676f695eeda169d0f8c618adf27c04b_***_Julian Halcox
author Ashley Akbari
Fatemeh Torabi
Joe Hollinghurst
Daniel Harris
Julian Halcox
author2 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
format Journal article
container_title Age and Ageing
container_volume 53
container_issue 2
publishDate 2024
institution Swansea University
issn 0002-0729
1468-2834
doi_str_mv 10.1093/ageing/afae021
publisher Oxford University Press (OUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description 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.
published_date 2024-02-22T21:46:47Z
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