Application of the simple atrial fibrillation better care pathway for integrated care management in frail patients with atrial fibrillation: A nationwide cohort study
Application of the simple atrial fibrillation better care pathway for integrated care management in frail patients with atrial fibrillation: A nationwide cohort study
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DOI：
10.1002/joa3.12364
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发表时间：
2020-06-05
影响因子：
2
通讯作者：
Joung, Boyoung
中科院分区：
文献类型：
--
作者：
Yang, Pil-Sung;Sung, Jung-Hoon;Joung, Boyoung
背景：综合护理管理对虚弱房颤（AF）患者的益处尚不清楚。本研究评估了是否遵守房颤更好的护理（ABC）路径的综合护理management. Methods，将改善临床结果在虚弱AF patients.Methods从韩国国民健康保险服务数据库，262,987非瓣膜性AF患者之间的2005年1月1日和2015年12月31日入组。对于每例患者，使用所有可用的ICD-10诊断代码回顾性计算医院虚弱风险评分和类别。患者被分为三个基于虚弱的风险类别：低（15分，n = 4,104）。结果平均随访5.9（四分位距3.2，9.4）年，在高虚弱风险患者中，ABC组的全因死亡率较低（6.5 vs 17.5/100人-年，P < .001;风险比[HR] 0.74; 95%置信区间[CI] 0.56-0.97），但对复合结局无显著性影响（10.5 vs 26.0/100人-年，P = 0.101; HR 0.79; 95% CI 0.59-1.05）。当比较三个虚弱类别时，在高虚弱组中观察到死亡率的最大益处（p（int）< 0.001），但对于复合结局，三个虚弱类别之间没有统计学相互作用（p（int）= 0.063）。考虑到与虚弱AF患者相关的高医疗负担，应实施综合AF管理以改善这些患者的结局。
Background The benefit of integrated care management was unknown in frail atrial fibrillation (AF) patients. This study evaluated whether compliance with the atrial fibrillation Better Care (ABC) pathway for integrated care management would improve clinical outcomes in frail AF patients.Methods From the Korea National Health Insurance Service database, 262,987 nonvalvular AF patients were enrolled between 1 January 2005 and 31 December 2015. For each patient, the Hospital Frailty Risk Score and category were calculated retrospectively using all available ICD-10 diagnostic codes. Patients were divided into three frailty-based risk categories: low (15 points, n = 4,104).Results Over a mean follow-up of 5.9 (interquartile range 3.2, 9.4) years, in high frailty risk patients, the ABC group had lower rates of all-cause death (6.5 vs 17.5 per 100 person-years, P < .001; hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.56-0.97) but was nonsignificant for the composite outcome (10.5 vs 26.0 per 100 person-years, P = .101; HR 0.79; 95% CI 0.59-1.05) compared with the Non-ABC group. When the three frailty categories were compared, the greatest benefit on mortality was seen in the high frailty group (p(int) < 0.001), but for the composite outcome, there was no statistical interaction for the three frailty categories (p(int) = 0.063).Conclusions Compliance with the simple ABC pathway is associated with improved outcomes in AF patients with high frailty risk. Given the high healthcare burden associated with frail AF patients, integrated AF management should be implemented to improve outcomes in these patients.