Adherence to Atrial Fibrillation Better Care (ABC) Pathway Management of Chinese Community Elderly Patients with Atrial Fibrillation: A Cross-Sectional Study

Figures & data

Figure 1 Flow chart of AF patients’ selection.

Table 1 Sociodemographic and Clinical Characteristics of the AF Patients

	Frequency	Percentage (%)
Demographic, n (%)
Sex
Female	94	47.7
Male	103	52.3
Age
65–74 years	80	40.6
≥75 years	117	59.4
Educational level
Junior middle school or below	70	35.5
Senior middle school or above	127	64.5
Marital status
Married	166	84.3
Divorced/ Widowed/Single	31	15.7
Medical insurance
Free medical care	11	5.6
Urban employee medical insurance	173	87.8
Other medical insurance	11	5.6
No	2	1.0
Disease course, n (%)
<1 year	26	13.2
≥1 year	171	86.8
Stroke or bleeding risk scores, n (%)
CHA2DS2-VASc
Score ≤1 (male); Score ≤2 (female)	23	11.7
Score ≥2 (male); Score ≥3 (female)	174	88.3
HAS-BLED
Score ≤2	122	87.8
Score ≥3	17	12.2
Comorbidities, n (%)
Multimorbidity	167	84.8
Hypertension	142	72.1
Diabetes	49	24.9
Dyslipidaemia	56	28.4
CAD	57	28.9
HF	9	4.6
Stroke/TIA	27	13.7
PAD	5	2.5
BMI ≥28 kg/m2	21	11.5
Concomitant treatment, n (%)
Polypharmacy	12	6.1
Anticoagulants	22	11.2
Warfarin	8	4.1
NOAC	14	7.1
Rhythm or heart rate control drugs	76	38.6
β-blocker	73	37.1
Amiodarone	4	2.0
Digoxin	3	1.5
Antiplatelet drugs	23	11.7
ACEI	9	4.6
ARB	60	30.5
CCB	76	38.6
Diuresis	20	10.2
Insulin/oral antidiabetic drugs	38	19.3
LLD	40	20.3
RFCA	46	23.4

Abbreviations: ACEI, angiotensin-converting-enzyme inhibitor; AF, atrial fibrillation; ARB, angiotensin receptor blockers; BMI, body mass index; CAD, coronary artery disease; CCB, calcium channel blocker; CHA₂DS₂-VASc, congestive heart failure, hypertension, age ≥75 years, diabetes, stroke/transient ischemic attack, vascular disease, age 65–74 years, sex category; HAS-BLED, hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalised ratio, elderly (>65 years), drugs or alcohol concomitantly; HF, heart failure; LLD, lipid-lowering drug; NOAC, non-vitamin K antagonist oral anticoagulant; PAD, peripheral arterial disease; RFCA, radiofrequency catheter ablation; TIA, transient ischemic attack.

Table 2 Adherence to ABC Pathway Management and Its Components Among AF Patients

	Adherence N (%)	Non-Adherence N (%)
A pathway	43 (21.8)	154 (78.2)
B pathway	163 (82.7)	34 (17.3)
C pathway	62 (31.5)	135 (68.5)
Hypertension	86 (65.6)	45 (34.4)
HF	2 (22.2)	7 (77.8)
CAD	1 (1.8)	56 (98.2)
Dyslipidaemia	12 (38.9)	44 (61.1)
Stroke/TIA	6 (22.2)	21 (77.8)
Diabetes	38 (77.6)	11 (22.4)
PAD	3 (60.0)	2 (40.0)
BMI kg/m^2	162 (88.5)	21 (11.5)
All ABC pathway	18 (9.1)	177 (90.9)

Abbreviations: AF, atrial fibrillation; CAD, coronary artery disease; HF, heart failure; TIA, transient ischemic attack; PAD, peripheral arterial disease; BMI, body mass index.

Table 3 Adherence to ABC Pathway Management According to the Sociodemographic and Clinical Characteristics of AF Patients

	A Component (n= 43)		B Component (n= 163)		C Component (n= 62)		ABC Pathway (n= 18)
	Adherence	Non-Adherence	Adherence	Non-Adherence	Adherence	Non-Adherence	Adherence	Non-Adherence
Sex, n (%)
Female	23 (24.5)	71 (75.5)	74 (78.7)	20 (21.3)	27 (28.7)	67 (71.3)	6 (6.4)	88 (93.6)
Male	20 (19.4)	83 (80.6)	89 (86.4)	14 (13.6)	35 (34.0)	68 (66.0)	12 (11.7)	91 (88.3)
χ^2 (P)	0.735 (0.391)		2.032 (0.154)		0.630 (0.427)		1.643 (0.200)
Age, n (%)
65–74 years	32 (40.0)	48 (60.0)	69 (86.3)	11 (13.8)	31 (38.8)	49 (61.3)	15 (18.8)	65 (81.3)
≥75 years	11 (9.4)	106 (90.6)	94 (80.3)	23 (19.7)	31 (26.5)	86 (73.5)	3 (2.6)	114 (97.4)
χ^2 (P)	26.070 (<0.001)*		1.161 (0.281)		3.308 (0.069)		13.107 (<0.001)*
Marital status, n (%)
Married	37 (22.3)	129 (77.7)	138 (83.1)	28 (16.9)	55 (33.1)	111 (66.9)	16 (9.6)	150 (90.4)
Divorced/Widowed/Single	6 (19.4)	25 (80.6)	25 (80.6)	6 (19.4)	7 (22.6)	24 (77.4)	2 (6.5)	29 (93.5)
χ^2 (P)	0.132 (0.717)		0.113 (0.737)		1.349 (0.246)		0.320 (0.572)
Academic level, n (%)
Junior middle school or below	18 (25.7)	52 (74.3)	58 (82.9)	12 (17.1)	22 (31.4)	48 (68.6)	8 (11.4)	62 (88.6)
Senior middle school or above	25 (19.7)	102 (80.3)	105 (82.7)	22 (17.3)	40 (31.5)	87 (68.5)	10 (9.7)	117 (92.1)
χ^2 (P)	0.961 (0.327)		0.001 (0.974)		0.001 (0.992)		0.687 (0.407)
Disease course, n (%)
<1 year	10 (38.5)	16 (61.5)	16 (61.5)	10 (38.5)	10 (38.5)	16 (61.5)	2 (7.7)	24 (92.4)
≥1 year	33 (19.3)	138 (80.7)	147 (86.0)	24 (14.0)	52 (30.4)	119 (69.6)	16 (9.4)	155 (90.6)
χ^2 (P)	4.857 (0.028)*		9.430 (0.002)*		0.678 (0.410)		<0.001 (1.000)
Polypharmacy, n (%)
Yes	0 (0.0)	12 (100.0)	10 (83.3)	2 (16.7)	2 (16.7)	10 (83.3)	0 (0.0)	12 (100.0)
No	43 (23.2)	142 (76.8)	153 (82.7)	32 (17.3)	60 (32.4)	125 (67.6)	18 (9.7)	167 (90.3)
χ^2 (P)	— (0.072)		<0.001 (1.000)		0.671 (0.431)		— (0.607)
Multimorbidity, n (%)
Yes	20 (12.0)	147 (88.0)	137 (82.0)	30 (18.0)	40 (24.0)	127 (76.0)	3 (1.8)	164 (98.2)
No	23 (76.7)	7 (23.3)	26 (86.7)	4 (13.3)	22 (73.3)	8 (26.7)	15 (50.0)	15 (50.0)
χ^2 (P)	62.373 (<0.001)*		0.126 (0.722)		28.754 (< 0.001)*		65.489 (<0.001)*
CHA2DS2-VASc Score, n (%)
≤1 (male); ≤2 (female)	23 (100.0)	0 (0.0)	20 (87.0)	3 (13.0)	15 (65.2)	8 (34.8)	13 (56.5)	10 (43.5)
≥2 (male); ≥3 (female)	20 (11.5)	154 (88.5)	143 (82.2)	31 (17.8)	47 (27.0)	127 (73.0)	5 (2.9)	169 (97.1)
χ^2 (P)	— (<0.001)*		0.076 (0.783)		13.749 (<0.001)*		70.425 (<0.001)*
HAS-BLED Score, n (%)
≤2	34 (27.9)	88 (72.1)	97 (79.5)	25 (20.5)	36 (29.5)	86 (70.5)	13 (10.7)	109 (89.3)
≥3	5 (29.4)	12 (70.6)	12 (70.6)	5 (29.4)	2 (11.8)	15 (88.2)	1 (5.9)	16 (94.1)
χ^2 (P)	0.018 (0.894)		0.701 (0.402)		1.556 (0.212)		0.033 (0.855)

Note: *p-value <0.05.

Abbreviations: AF, atrial fibrillation; CHA₂DS₂-VASc, congestive heart failure, hypertension, age ≥75 years, diabetes, stroke/transient ischemic attack, vascular disease, age 65–74 years, sex category; HAS-BLED, hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalised ratio, elderly (>65 years), drugs or alcohol concomitantly.

Table 4 Sex-Adjusted Factors Independently Associated with Non-Adherence to the ABC Pathway Management Among AF Patients

	β	S.E	Wald χ^2	OR	95% CI		p-value
A component
Age (years)
65–74				1.000
≥75	1.754	0.463	14.353	5.776	2.331	14.310	<0.001*
Multimorbidity	3.053	0.534	32.656	21.179	7.433	60.348	<0.001*
B component
Disease course (<1 year)				1.000
Disease course (≥1 year)	−1.374	0.465	8.739	0.253	0.102	0.629	0.003*
C component
Multimorbidity	2.173	0.452	23.095	8.780	3.620	21.297	<0.001*
ABC pathway
Age (years)
65–74				1.000
≥75	1.540	0.750	4.216	4.665	1.072	20.291	0.040*
Multimorbidity	3.826	0.724	27.960	45.891	11.112	189.528	<0.001*

Note: *p-value <0.05.