目的 了解中国急诊室就诊的心房颤动（房颤）患者1年随访的主要终点事件情况，探讨房颤更好的管理（Atrial fibrillation Better Care , ABC）路径对中国急诊房颤患者预后的影响。

方法 本研究纳入自2008年11月至2011年10月在中国20家医院急诊就诊的房颤患者，并随访12个月。根据患者是否符合ABC管理路径（A，抗凝/避免卒中；B，更好的症状管理；C，降低心血管和其他共病风险管理）分为2组：符合ABC路径组和不符合ABC路径组。主要临床结局事件为全因死亡，次要临床结局事件为心血管死亡、卒中和大出血事件。应用单因素和多因素Cox回归模型分析ABC管理路径的符合情况对上述事件的影响。

结果 本研究共纳入2015例房颤患者，平均年龄68.5±13.3岁，其中女性1104例（54.8%）。符合/不符合ABC路径组的患者分别为126例（6.3%）和1889例（93.7%）。符合ABC路径组患者年龄偏小、心率偏慢、永久性房颤、高血压、糖尿病、心脏瓣膜病、短暂脑缺血发作/卒中史的比率更高。在12个月随访中，符合ABC路径组和不符合ABC路径组死亡患者例数分别为4例（3.2%）和275例（14.6%），其中心血管死亡两组分别1例（0.8%）和163例（8.6%），卒中和大出血发生率在二组无统计学差异。多因素Cox模型分析显示，与不符合ABC路径组相比，符合ABC路径组的全因死亡 (HR 0.211，95% CI  0.078-0.572，p=0.002）和心血管死亡风险（HR 0.085，95%CI  0.012-0.612， p=0.014）均显著下降。

结论 在当代真实的中国急诊房颤患者队列中，符合ABC路径的临床综合管理与显著降低全因死亡、心血管死亡风险相关，采用ABC路径的综合管理可以改善房颤患者的预后。

Objective  To investigate the primary endpoint events of patients with Atrial fibrillation (AF) in emergency department in China during one year follow-up, and to explore the impact of Atrial fibrillation Better Care (ABC) pathway on the prognosis of Chinese emergency patients with AF.

Methods  This study included patients with AF who presented to the emergency department of 20 hospitals in China from November 2008 to October 2011, and every patient had a 12-months follow-up. Patients were divided into 2 groups according to whether they followed the ABC pathway（A, anticoagulation/Avoid stroke; B, Better symptom management; and C, Cardiovascular and other comorbidity risk reduction.）: ABC adherent and Non-ABC adherent. The primary clinical outcome measure was all-cause death, and the secondary clinical outcome measure was cardiovascular death, stroke, and major bleeding. Univariate and multivariable Cox regression models were used to analyze the effects of the ABC adherence on the clinical outcomes.

Results  A total of 2015 patients with AF were included in this study, the average age was 68.5±13.3 years, 1104 (54.8%) were female. and the patients in the ABC/Non-ABC adherent were 126 (6.3%) and 1889 (93.7%), respectively. The ABC adherent patients were younger, with slower heart rate; and had higher proportion of permanent AF, hypertension, diabetes, valvular heart disease, and transient ischemia attack /stroke. During the 12-month follow-up, All-cause death and cardiovascular death occurred in 4 (3.2%) patients and 1 (0.8%) in the ABC adherent group, and 275 (14.6%) and 163 (8.6%) in the Non-ABC adherent group. Multivariable Cox model analysis showed that the risk of all-cause mortality (HR 0.211, 95% CI 0.078-0.572, p=0.002) and cardiovascular mortality (HR 0.085, 95% CI 0.012-0.612, p=0.014) was significantly decreased in the ABC adherent group compared with the Non-ABC adherent group. The incidence of stroke and major bleeding was not statistically different between the two groups.

Conclusion  In a contemporary cohort of Chinese emergency patients with AF, comprehensive clinical management with the ABC pathway was associated with a significant decrease in the risk of all-cause death and cardiovascular death, and integrated management using the ABC pathway could improve the prognosis of patients with AF.