A mobile health (mHealth) technology program that implemented the Atrial Fibrillation Better Care (ABC) pathway was found to reduce meaningful clinical adverse events among older patients with atrial fibrillation (AF) and multimorbidity compared with usual care. The study findings were published in JAMA Network Open.
The Mobile Health Technology for Improved Screening and Optimized Integrated Care in Atrial Fibrillation (mAFA-II) trial was a prospective cluster randomized trial conducted at 40 centers in China between 2018 and 2021. Older patients with AF were enrolled at centers, where they were randomly assigned to receive the intervention (patients: n=833; centers: n=20) or usual care (patients: n=1057; centers: n=20). The intervention comprised (A) anticoagulation assessment to avoid stroke, (B) better symptom control through medication adjustment, and (C) cardiovascular disease and comorbidity management by monitoring blood pressure. The primary outcome was the composite incidence of stroke or thromboembolism, all-cause mortality, and rehospitalization.
The intervention and control cohorts had a mean age of 72.0± 12.0 and 72.8±13.0 years; 33.4% and 41.9% were women; and mean follow-up time was 419±257 and 457±154 days, respectively.
The primary composite outcome occurred less frequently among the intervention cohort (hazard ratio [HR], 0.37; 95% CI, 0.26-0.53; P <.001).
Stratified by event, risk for rehospitalization (HR, 0.42; 95% CI, 0.27-0.64; P <.001) and stroke or thromboembolism (HR, 0.17; 95% CI, 0.05-0.51; P =.002) was decreased among the intervention cohort, but not risk for mortality (HR, 0.52; 95% CI, 0.27-1.00; P =.06).
In subgroup analyses, the intervention was favored for both men and women, patients aged greater than or equal to 75 or greater than 75 years, and with or without prior stroke for decreasing risk for the primary composite outcome (all P <.001) and rehospitalization (all P £.02).
This study had limited power to evaluate some of the study outcomes, and cohorts were imbalanced due to its cluster design.
“In this prespecified ancillary analysis from the mAFA-II trial, an mHealth technology-based integrated care approach that facilitates the implementation of the ABC pathway reduced meaningful clinical adverse events in older patients with AF and multimorbidity compared with usual care,” the study authors noted.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Yao Y, Guo Y, Lip GYH, et al. The effects of implementing a mobile health–technology supported pathway on atrial fibrillation–related adverse events among patients with multimorbidity: the mAFA-II randomized clinical trial. JAMA Netw Open. 2021;4(12):e2140071. doi:10.1001/jamanetworkopen.2021.40071