Author + information
- Received November 13, 2019
- Revision received January 14, 2020
- Accepted January 21, 2020
- Published online March 30, 2020.
- Yutao Guo, MD, PhDa,
- Deirdre A. Lane, PhDb,
- Limin Wang, MD, PhDc,
- Hui Zhang, MDa,
- Hao Wang, MD, PhDa,
- Wei Zhang, MDd,
- Jing Wen, MDe,
- Yunli Xing, MD, PhDf,
- Fang Wu, MD, PhDg,
- Yunlong Xia, MD, PhDh,
- Tong Liu, MD, PhDi,
- Fan Wu, MD, PhDj,
- Zhaoguang Liang, MD, PhDk,
- Fan Liu, MD, PhDl,
- Yujie Zhao, MDm,
- Rong Li, MD, PhDn,
- Xin Li, MD, PhDo,
- Lili Zhang, MD, PhDp,
- Jun Guo, MD, PhDa,
- Girvan Burnside, PhDq,
- Yundai Chen, MD, PhDa,∗∗ (, )
- Gregory Y.H. Lip, MDa,b,∗ (, )
- on behalf of the mAF-App II Trial Investigators
- aMedical School of Chinese PLA, Department of Cardiology, Chinese PLA General Hospital, Beijing, China
- bLiverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom, and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- cThe National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- dDepartment of Gerontology and Geriatric Medicine, Seventh Clinical Center, Chinese PLA General Hospital, Beijing, China
- eDepartment of Geriatric Cardiology, Haidian Hospital, Beijing, China
- fBeijing Friendship Hospital, Capital Medical University, Beijing, China
- gDepartment of Gerontology and Geriatric Medicine, Ruijin Hospital Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai, China
- hDepartment of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- iTianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- jDepartment of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China
- kDepartment of Cardiology, First Affiliated Hospital of Haerbing Medical University, Haerbing, China
- lDepartment of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, China
- mDepartment of Cardiology, Henan Cardiovascular Hospital Affiliated to Southern Medical University, Henan, China
- nDepartment of Cardiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- oDepartment of Cardiology, Benq Medical Center, Nanjing Medical University, Nanjing, China
- pDepartment of Cardiology, Longhua People’s Hospital, Shenzhen, China
- qDepartment of Biostatistics, University of Liverpool, Liverpool, United Kingdom
- ↵∗Addresses for correspondence:
Prof. Gregory Y.H. Lip, Liverpool Centre for Cardiovascular Science, William Henry Duncan Building, 6 West Derby St, Liverpool, Merseyside L7 8TX, United Kingdom.
- ↵∗∗Prof. Yundai Chen, Chinese PLA General Hospital, Department of Cardiology, No. 28, Fuxin Rd, Beijing 100853, China.
Background 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.
Objective 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.
Methods 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.
Results 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).
Conclusions 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).
This research project was funded by the National Natural Science Foundation of China (H2501), National Key Research and Development Project of China (2018YFC2001200), and the Health and Family Planning Commission of Heilongjiang Province, China (2017-036), and was partly supported by the National Institute for Health Research (NIHR) Global Health Research Group on Atrial Fibrillation management at the University of Birmingham, United Kingdom. This study was an investigator-initiated project, with limited funding by independent research and educational grants. Funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Dr. Lip is a consultant for Bayer/Janssen, Bristol-Myers Squibb/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo; and is a speaker for Bayer, Bristol-Myers Squibb/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo (no fees are directly received personally). Dr. Lane has received grants from Bristol-Myers Squibb and Boehringer Ingelheim (paid to the institution); and has received personal fees from Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Bayer, and Daiichii-Sankyo, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 13, 2019.
- Revision received January 14, 2020.
- Accepted January 21, 2020.
- 2020 American College of Cardiology Foundation
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