Patterns of comorbidities, clinical course, and impact of the ABC Pathway for Integrated Care in patients with atrial fibrillation: a report from the prospective Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) Registry

AIMS: To identify comorbidity patterns in elderly Chinese patients with atrial fibrillation (AF), their clinical course, and the effectiveness of the Atrial fibrillation Better Care (ABC) pathway adherence among these phenotypes. METHODS AND RESULTS: From the ChiOTEAF Registry, we performed a latent class analysis based on 16 cardiovascular (CV) and non-CV conditions. The association between classes of patients, management, and outcomes was evaluated. The primary outcome was a composite of all-cause death and major adverse CV events. We assessed the impact of ABC adherence on outcomes in the whole cohort and among phenotypes. We included 4765 AF patients [median age 77 (68-83) years, 39.1% females]. Four phenotypes were identified: (i) low complexity (48.9%); (ii) atherosclerotic (19.3%); (iii) heart failure (19.4%); and (iv) high complexity (12.3%). During a 1-year follow-up, compared to the 'low complexity' class, the risk of adverse events was higher in 'high complexity' [aOR, 95% confidence interval (CI): 3.20, 2.21-4.66] and 'heart failure' classes (aOR, 95% CI: 1.50, 1.04-2.17). Among 2654 patients [median age 75 (66-81) years, 43.3% females] with available information to assess the ABC pathway, 1094 (41.2%) were adherent. ABC pathway adherence was associated with a lower risk of adverse events (aOR, 95% CI: 0.37, 0.20-0.65). On interaction analysis, its beneficial effect was similar across different clinical phenotypes (Pint = 0.122). CONCLUSION: Different clinical phenotypes can be identified in Asian AF patients, with specific patterns of comorbidities and different risks of adverse events. Full ABC pathway adherence was associated with improved outcomes, regardless of the clinical phenotype.