BACKGROUND: Implementation of the Atrial fibrillation Better Care (ABC) pathway is recommended by guidelines on atrial fibrillation (AF), but the impact of adherence to ABC pathway in patients with cancer is unknown. OBJECTIVES: To investigate the adherence to ABC pathway and its impact on adverse outcomes in AF patients with cancer. METHODS: Patients enrolled in the EORP-AF General Long-Term Registry were analyzed according to (i) No Cancer; and (ii) Prior or active cancer and stratified in relation to adherence to the ABC pathway. The composite Net Clinical Outcome (NCO) of all-cause death, major adverse cardiovascular events and major bleeding was the primary endpoint. RESULTS: Among 6550 patients (median age 69 years, females 40.1%), 6005 (91.7%) had no cancer, while 545 (8.3%) had a diagnosis of active or prior cancer at baseline, with the proportions of full adherence to ABC pathway of 30.6% and 25.7%, respectively. Adherence to the ABC pathway was associated with a significantly lower occurrence of the primary outcome vs. non-adherence, both in 'no cancer' and 'cancer' patients [adjusted Hazard Ratio (aHR) 0.78, 95% confidence interval (CI): 0.66-0.92 and aHR 0.59, 95% CI 0.37-0.96, respectively]. Adherence to a higher number of ABC criteria was associated with a lower risk of the primary outcome, being lowest when 3 ABC criteria were fulfilled (no cancer: aHR 0.54, 95%CI: 0.36-0.81; with cancer: aHR 0.32, 95% CI 0.13-0.78). CONCLUSION: In AF patients with cancer enrolled in the EORP-AF General Long-Term Registry, adherence to ABC pathway was sub-optimal. Full adherence to ABC-pathway was associated with a lower risk of adverse events.

ANMCO Research Center Firenze Italy

Cardiology Division Department of Biomedical Metabolic and Neural Sciences University of Modena and Reggio Emilia Policlinico di Modena Via del Pozzo 71 Modena 41124 Italy

Cardiology Division Department of Biomedical Metabolic and Neural Sciences University of Modena and Reggio Emilia Policlinico di Modena Via del Pozzo 71 Modena 41124 Italy; Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart and Chest Hospital Liverpool United Kingdom

Cardiology Division Department of Biomedical Metabolic and Neural Sciences University of Modena and Reggio Emilia Policlinico di Modena Via del Pozzo 71 Modena 41124 Italy; Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart and Chest Hospital Liverpool United Kingdom; Clinical and Experimental Medicine PhD Program University of Modena and Reggio Emilia Modena Italy

Carol Davila' University of Medicine Colentina University Hospital Bucharest Romania

Department of Cardiology Hospital Universitario Virgen de la Arrixaca IMIB Arrixaca University of Murcia CIBERCV Murcia Spain

Department of Cardiology Ludwig Maximilians University Munich Germany

Department of Cardiology SMDZ in Zabrze Medical University of Silesia Katowice Silesian Centre for Heart Diseases Zabrze Poland

Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart and Chest Hospital Liverpool United Kingdom; Department of Clinical Medicine Aalborg University Aalborg Denmark

Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart and Chest Hospital Liverpool United Kingdom; Department of Clinical Sciences and Community Health University of Milan Milan Italy; Geriatric Unit IRCCS Istituti Clinici Scientifici Maugeri Milan Italy

Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart and Chest Hospital Liverpool United Kingdom; Department of Translational and Precision Medicine Sapienza University of Rome Rome Italy

School of Medicine University of Belgrade Belgrade Serbia; Intensive Arrhythmia Care Cardiology Clinic Clinical Center of Serbia Belgrade Serbia

Service de Cardiologie Centre Hospitalier Universitaire Trousseau Tours France

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