Tailored Risk-based Treatment Does Not Improve Outcomes In Atrial Fibrillation

An individually tailored multidimensional risk-based curen strategy was not associated pinch improvements successful objective outcomes compared pinch accustomed guideline-based attraction successful patients pinch atrial fibrillation (AF), according to late-breaking investigation presented successful a Hot Line convention coming astatine ESC Congress 2025.

Patients pinch AF are astatine accrued consequence of changeable and are often treated pinch oral anticoagulant (OAC) therapy, chiefly nonstop OACs aliases warfarin. While OACs substantially trim nan consequence of stroke, they whitethorn besides summation nan consequence of bleeding events. ESC Guidelines urge that a risk-based attack is utilized to make decisions connected OACs and different treatments for changeable prevention successful patients pinch AF.

Several biomarker-based consequence scores for changeable and bleeding person been developed. These see nan biomarker-based ABC-AF-stroke people (Age, Biomarkers [NT-proBNP and hs-troponin T] and Clinical history of stroke/transient ischaemic attack) and nan ABC-AF-bleeding people (Age, Biomarkers [growth differentiation facet 15, haemoglobin and hs-troponin T] and Clinical history of bleeding).

Principal Investigator, Professor Jonas Oldgren from Uppsala University, Uppsala, Sweden, explained why and really implementation of these consequence scores was assessed successful nan ABC-AF trial: "While caller biomarker-based consequence scores person been validated successful different populations, nan objective inferior of consequence scores to guideline curen decisions and amended objective outcomes has seldom been prospectively evaluated. We performed a pragmatic registry-based proceedings to measure whether nan tailoring of curen recommendations based connected patients' ABC-AF consequence scores improves objective outcomes arsenic compared pinch accustomed guideline-based attraction successful patients pinch AF."

This open-label registry-based, randomised controlled study enrolled patients from 39 Swedish sites. Eligible patients were adults pinch a test of AF, including recently aliases antecedently diagnosed AF, pinch aliases without existent OAC treatment. Patients were randomised 1:1 to either an ABC-AF consequence score-guided curen strategy aliases to modular of care. Plasma samples were obtained astatine randomisation and ABC-AF consequence scores were automatically calculated based connected nan ABC-AF-stroke variables and nan ABC-AF-bleeding variables. The interrogator received a ocular position of nan ABC-AF consequence scores on pinch circumstantial curen recommendations tailored to each individual patient. Based connected this information, nan interrogator decided connected aesculapian treatments and different interventions. Patients successful nan power limb were managed successful accordance pinch accustomed practices astatine nan discretion of nan investigator, without measurements of immoderate ABC-AF consequence people biomarkers and without individual curen recommendations. The superior result was a composite of changeable aliases death. Data for study outcomes were retrieved from mandatory nationalist registers pinch complete sum of each in-patient attraction astatine Swedish hospitals and captious position for each Swedish residents. Enrolment was prematurely terminated owing to information concerns pinch a inclination towards higher mortality successful patients pinch CHA2DS2-VASc scores of 3 aliases above.

The intention-to-treat organization comprised 3,933 patients who had a median property of 73.9 years and 33.6% were women. In total, 51.3% had paroxysmal AF, 11.2% had anterior changeable aliases transient ischaemic onslaught and 85.7% had OAC treatment.

After randomisation, nan proportionality of patients receiving immoderate OAC accrued to 97.8% successful nan progressive limb and 92.6% successful nan power limb (p<0.0001). In nan progressive group, location were changes successful nan usage of immoderate nonstop OACs - accrued usage of apixaban and dabigatran, and reductions successful rivaroxaban - and reductions successful nan usage of warfarin. In nan power group, location was accrued usage of apixaban, edoxaban and rivaroxaban, and reductions successful nan usage of warfarin. In some study groups, nan proportionality of patients connected antiplatelet curen was halved and statin curen increased.

Over a median follow-up of 2.6 years, nan superior result occurred astatine a akin complaint betwixt nan groups: 3.18/100 patient-years (100PY) successful nan progressive group and 2.67/100PY successful nan power group (hazard ratio [HR] 1.19; 95% assurance interval [CI] 0.96 to 1.48; p=0.12).

There were nary important differences successful nan progressive vs. power groups successful nan complaint of changeable (0.87/100PY vs. 0.74/100PY; HR 1.18; 0.78 to 1.79; p=0.44) aliases decease (2.44/100PY vs. 2.02/100PY; HR 1.21; 0.94 to 1.55; p=0.13).

Major bleeding events occurred astatine a akin complaint successful nan progressive vs. power group (2.82/100PY vs. 2.61/100PY; HR 1.08; 95% CI 0.86 to 1.36; p=0.50).

We recovered nary use of individually tailored, multidimensional curen recommendations based connected ABC-AF-stroke and ABC-AF-bleeding consequence scores compared pinch accustomed guideline-based attraction successful this study organization who had lower-than-expected arena rates. Due to premature termination of recruitment, nan study was underpowered for its superior objective, but we will proceed to follow-up randomised patients to measure immoderate semipermanent effects. Overall, nan results emphasise nan request for prospective testing of nan inferior of consequence stratification and precision medicine devices successful different objective settings earlier being implemented for tailoring of curen successful regular objective care."

Professor Jonas Oldgren, Uppsala University, Uppsala, Sweden