Mobile health technology integrated care in atrial fibrillation patients with diabetes mellitus in China: A subgroup analysis of the mAFA‐II cluster randomized clinical trial

Guo, Yutao, Corica, Bernadette ORCID: 0000-0001-9460-4435, Romiti, Giulio Francesco, Proietti, Marco ORCID: 0000-0003-1452-2478, Zhang, Hui and Lip, Gregory YH ORCID: 0000-0002-7566-1626 (2023) Mobile health technology integrated care in atrial fibrillation patients with diabetes mellitus in China: A subgroup analysis of the mAFA‐II cluster randomized clinical trial. European Journal of Clinical Investigation, 53 (9). e14031-.

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Official URL: http://dx.doi.org/10.1111/eci.14031

Abstract

<h4>Background</h4>The Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) prospective randomized trial showed the efficacy of a mobile health (mHealth) implemented 'Atrial fibrillation Better Care' (ABC) pathway for the integrated care management of patients with atrial fibrillation (AF). In this ancillary analysis, we evaluated the effect of mAFA intervention according to the history of diabetes mellitus (DM).<h4>Methods</h4>The mAFA-II trial enrolled 3324 AF patients across 40 centres in China, between June 2018 and August 2019. In this analysis, we assessed the interaction between history of DM and the effect of mAFA intervention on the risk of the primary composite outcome of stroke, thromboembolism, all-cause death and rehospitalizations. Results were expressed as adjusted hazard ratio (aHR) and 95% confidence intervals (95%CI). The effect of mAFA intervention on exploratory secondary outcomes was also assessed.<h4>Results</h4>Overall, 747 (22.5%) patients had DM (mean age: 72.7 ± 12.3, 39.6% females; 381 allocated to mAFA intervention). mAFA intervention was associated with a significant risk reduction for the primary composite outcome both in patients with and without DM (aHR [95%CI]: .36 [.18-.73] and .37 [.23-.61], respectively, p for interaction = .941). A significant interaction was found only for the composite of recurrent AF, heart failure and acute coronary syndromes (p<sub>int</sub> =.025), with lower effect of mAFA intervention in patients with DM.<h4>Conclusions</h4>A mHealth-technology implemented ABC pathway showed a consistent effect in reducing the risk of the primary composite outcome in AF patients with and without DM.<h4>Trial registration</h4>WHO International Clinical Trials Registry Platform (ICTRP) Registration number: ChiCTR-OOC-17014138.

Item Type:	Article
Uncontrolled Keywords:	atrial fibrillation, diabetes mellitus, integrated care, outcomes
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	01 Jun 2023 09:38
Last Modified:	24 Aug 2023 09:28
DOI:	10.1111/eci.14031
Open Access URL:	https://doi.org/10.1111/eci.14031
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3170777