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Thromb Haemost
DOI: 10.1055/a-2787-0186
Original Article: Stroke, Systemic or Venous Thromboembolism

The ‘Atrial Fibrillation Better Care’ 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
    2   Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom

  • Bernadette Corica   ‡

    2   Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
    3   Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy

  • Tommaso Bucci 

    2   Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom

  • José Miguel Rivera-Caravaca 

    2   Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
    4   Faculty of Nursing, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Pascual Parrilla), CIBERCV, Murcia, Spain

  • Francisco Marín

    5   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 

    6   Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
    7   Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark

  • Gheorghe-Andrei Dan

    8   Carol Davila University of Medicine, Academy of Romanian Scientists, Bucharest, Romania

  • Tatjana S. Potpara 

    9   Medical Faculty, University of Belgrade, Belgrade, Serbia
    10   Intensive Arrhythmia Care, Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia

  • Mariya Tokmakova

    11   Division of Cardiology, First Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria

  • Aldo Pietro Maggioni

    12   ANMCO Research Centre, Heart Care Foundation, Florence, Italy

  • Søren Paaske Johnsen 

    6   Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

  • Deirdre A. Lane 

    2   Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
    13   Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
    14   Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark

  • Gregory Y.H. Lip    ‡‡

    2   Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
    14   Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
    15   Department of Cardiology, Lipidology and Internal Medicine with Intensive Coronary Care Unit, Medical University of Bialystok, Bialystok, Poland

  • Marco Proietti   ‡‡

    16   Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
    17   Division of Cardiogeriatric Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
    • AF-COMET Collaborative Group

Funding Information This study received no specific funding. G.F.R. was supported by a grant issued by Sapienza – University of Rome (AR22419077BB6154).
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Graphical Abstract

Abstract

Objective

To conduct an updated 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 Atrial Fibrillation (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 (Odds Ratio [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 the inclusion of estimates adjusted for potential confounders.

Conclusion

Adherence to the ABC pathway remains suboptimal 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.

Keywords

atrial fibrillation - integrated care - ABC pathway - management - outcomes

‡ These authors share first authorship.


‡‡ These authors share senior authorship.


‡‡‡ The details of the AF-COMET collaborative group is Listed in the [Supplementary Appendix] (available in the online version only).


Supplementary Material



Publication History

Received: 26 November 2025

Accepted after revision: 12 January 2026

Accepted Manuscript online:
16 January 2026

Article published online:
30 January 2026

© 2026. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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