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Thromb Haemost
DOI: 10.1055/a-2787-0186
Original Article

The ‘Atrial Fibrillation Better Care’ (ABC) pathway for integrated care of Atrial Fibrillation: A Systematic Review and Meta-Analysis

Authors

  • Giulio Francesco Romiti 

    1   Department of Wellbeing, Health and Environmental Sustainability, Sapienza University of Rome, Rome, Italy (Ringgold ID: RIN9311)
    2   Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN4591)

  • Bernadette Corica

    3   University of Modena and Reggio Emilia, Modena, Italy (Ringgold ID: RIN9306)
    2   Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN4591)

  • Tommaso Bucci 

    4   University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN4591)

  • José Miguel Rivera-Caravaca 

    5   Faculty of Nursing, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Pascual Parrilla), CIBERCV, Murcia, Spain
    2   Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN4591)

  • Francisco Marín

    6   Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Pascual Parrilla), CIBERCV, Murcia, Spain

  • Lars Frost 

    7   Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg Universitet, Aalborg, Denmark (Ringgold ID: RIN1004)
    8   Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark

  • George-Andrei Dan

    9   University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania (Ringgold ID: RIN87267)

  • Tatjana S Potpara 

    10   Intensive Arrhythmia Care, Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
    11   Medical Faculty, University of Belgrade, Belgrade, Serbia (Ringgold ID: RIN54801)

  • Mariya Tokmakova

    12   Division of Cardiology, First Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria (Ringgold ID: RIN118870)

  • Aldo Pietro Maggioni

    13   ANMCO Research Center, Heart Care Foundation, Firenze, Italy

  • Søren Paaske Johnsen 

    14   Aalborg Universitetshospital, Aalborg, Denmark (Ringgold ID: RIN53141)
    15   Clinical Medicine, Aalborg Universitet, Aalborg, Denmark (Ringgold ID: RIN1004)

  • Deirdre Lane 

    16   Liverpool Centre of Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN4591)

  • Gregory YH Lip 

    2   Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN4591)
    17   Department of Clinical Medicine, Faculty of Health, Aalborg Universitet, Aalborg, Denmark (Ringgold ID: RIN1004)
    18   Department of Cardiology, Lipidology and Internal Medicine with Intensive Coronary Care Unit, Medical University of Bialystok, Bialystok, Poland (Ringgold ID: RIN37801)

  • Marco Proietti

    19   Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (Ringgold ID: RIN9304)
    20   Division of Cardiogeriatric Subacute Care, Istituti Clinici Scientifici Maugeri SpA IRCCS Milano, Milan, Italy (Ringgold ID: RIN203226)
Further Information
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Objective: To conduct a systematic review of the current evidence on the implementation of the ‘Atrial fibrillation Better Care’ (ABC) pathway for the comprehensive and holistic management of patients with AF. Patients and Methods: We performed a systematic review and meta-analysis, searching MEDLINE and EMBASE for studies reporting the prevalence of ABC-adherent management in patients with AF and its association with clinical outcomes (all-cause death, cardiovascular death, stroke, stroke/thromboembolism (TE), and major bleeding). Random-effects models were used to pool results from individual studies; subgroup analyses and meta-regressions were also conducted. Results: Overall, 22 studies were included (including 2 randomised trials), with >380,000 AF patients. Adherence to the ABC pathway was 23.9% (95%CI: 17.5%-31.7%), with substantial between-study heterogeneity (I2: 99.8%). Adherence was higher in European cohorts (37.9%, 95%CI: 27.8%-49.2%) and increased with advancing age. ABC pathway adherence was associated with a lower risk of all-cause death (OR: 0.49, 95%CI: 0.41-0.58, I²: 97.1%), cardiovascular death (OR: 0.46, 95%CI: 0.36-0.59, I²: 96.4%), stroke (OR: 0.65, 95%CI: 0.51-0.82, I²: 93.5%), stroke/TE (OR: 0.53, 95%CI: 0.42-0.66, I²: 91.1%) and major bleeding (OR: 0.81, 95%CI: 0.69-0.94, I²: 89.2%). The effect of the ABC pathway was consistent in clinical trials versus real-world studies, but influenced by study-level characteristics, including geographical location, mean age, prevalence of comorbidities, and estimates adjusted for potential confounders. Conclusions: Adherence to the ABC pathway remains sub-optimal in patients with AF, but is associated with substantial beneficial effects on prognosis. Our data support widespread implementation of the ABC pathway for managing patients with AF.



Publication History

Received: 26 November 2025

Accepted after revision: 12 January 2026

Accepted Manuscript online:
16 January 2026

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