Mobile Health Technology to Improve Care for Patients With Atrial Fibrillation

Current management of patients with atrial fibrillation (AF) is limited by low detection of AF, non-adherence to guidelines, and lack of consideration of patients' preferences, thus highlighting the need for a more holistic and integrated approach to AF management. The objective of this study w...

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Veröffentlicht in:Journal of the American College of Cardiology Jg. 75; H. 13; S. 1523
Hauptverfasser: Guo, Yutao, Lane, Deirdre A, Wang, Limin, Zhang, Hui, Wang, Hao, Zhang, Wei, Wen, Jing, Xing, Yunli, Wu, Fang, Xia, Yunlong, Liu, Tong, Wu, Fan, Liang, Zhaoguang, Liu, Fan, Zhao, Yujie, Li, Rong, Li, Xin, Zhang, Lili, Guo, Jun, Burnside, Girvan, Chen, Yundai, Lip, Gregory Y H
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 07.04.2020
Schlagworte:
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Atrial Fibrillation - complications
Atrial Fibrillation - mortality
Atrial Fibrillation - therapy
China - epidemiology
Female
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Stroke - etiology
Stroke - prevention & control
Telemedicine - statistics & numerical data
Thromboembolism - etiology
Thromboembolism - prevention & control
China
atrial fibrillation
adverse events
integrated care
mobile health
ISSN:1558-3597, 1558-3597
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Zusammenfassung:Current management of patients with atrial fibrillation (AF) is limited by low detection of AF, non-adherence to guidelines, and lack of consideration of patients' preferences, thus highlighting the need for a more holistic and integrated approach to AF management. The objective of this study was to determine whether a mobile health (mHealth) technology-supported AF integrated management strategy would reduce AF-related adverse events, compared with usual care. This is a cluster randomized trial of patients with AF older than 18 years of age who were enrolled in 40 cities in China. Recruitment began on June 1, 2018 and follow-up ended on August 16, 2019. Patients with AF were randomized to receive usual care, or integrated care based on a mobile AF Application (mAFA) incorporating the ABC (Atrial Fibrillation Better Care) Pathway: A, Avoid stroke; B, Better symptom management; and C, Cardiovascular and other comorbidity risk reduction. The primary composite outcome was a composite of stroke/thromboembolism, all-cause death, and rehospitalization. Rehospitalization alone was a secondary outcome. Cardiovascular events were assessed using Cox proportional hazard modeling after adjusting for baseline risk. There were 1,646 patients allocated to mAFA intervention (mean age, 67.0 years; 38.0% female) with mean follow-up of 262 days, whereas 1,678 patients were allocated to usual care (mean age, 70.0 years; 38.0% female) with mean follow-up of 291 days. Rates of the composite outcome of 'ischemic stroke/systemic thromboembolism, death, and rehospitalization' were lower with the mAFA intervention compared with usual care (1.9% vs. 6.0%; hazard ratio [HR]: 0.39; 95% confidence interval [CI]: 0.22 to 0.67; p < 0.001). Rates of rehospitalization were lower with the mAFA intervention (1.2% vs. 4.5%; HR: 0.32; 95% CI: 0.17 to 0.60; p < 0.001). Subgroup analyses by sex, age, AF type, risk score, and comorbidities demonstrated consistently lower HRs for the composite outcome for patients receiving the mAFA intervention compared with usual care (all p < 0.05). An integrated care approach to holistic AF care, supported by mHealth technology, reduces the risks of rehospitalization and clinical adverse events. (Mobile Health [mHealth] technology integrating atrial fibrillation screening and ABC management approach trial; ChiCTR-OOC-17014138).
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SourceType-Scholarly Journals-1
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ISSN:1558-3597
1558-3597
DOI:10.1016/j.jacc.2020.01.052