A multinational European network to implement integrated care in elderly multimorbid atrial fibrillation patients: the AFFIRMO Consortium

The increasing ageing of the general population has led to a significant burden of multimorbidity in the general population, requiring significant changes to healthcare and management, as well as clinical approaches. Hence, increasing attention to the progressively increasing burden of multimorbidity and the need for more integrated care management in patients with chronic long-term conditions.1,2 Even in the most common heart rhythm disorder, atrial fibrillation (AF), the presence of multimorbidity has proven to significantly influence clinical management and prognosis.3,4 The burden of multimorbidity in AF patients, similar to the overall general population, requires new strategies to manage patients and reduce the risk of adverse outcomes. This holistic or integrated care approach has been proposed and framed as the ‘Atrial fibrillation Better Care’ (ABC) pathway5 and is based on three main pillars: (i) ‘A’: avoid stroke by anticoagulation management; (ii) ‘B’: better symptom control by patient-centred symptom-directed decisions on rate or rhythm control strategies; (iii) ‘C’: cardiovascular and non-cardiovascular risk factors and comorbidities, as well as lifestyle changes. Adherence to the ABC pathway has been shown to improve clinical outcomes, including the reduction in mortality, stroke, major bleeding, and hospitalizations.6 Given the growing evidence-base, the ABC pathway has been recommended in AF clinical management guidelines from Europe and Asia-Pacific.7,8