Mobile Health Technology to Improve Care for Patients With Atrial Fibrillation

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Guo, Yutao, Lane, Deirdre A, Wang, Limin, Zhang, Hui, Wang, Hao, Zhang, Wei, Wen, Jing, Xing, Yunli, Wu, Fang, Xia, Yunlong et al (show 83 more authors) , Liu, Tong, Wu, Fan, Liang, Zhaoguang, Liu, Fan, Zhao, Yujie, Li, Rong, Li, Xin, Zhang, Lili, Guo, Jun, Burnside, Girvan ORCID: 0000-0001-7398-1346, Chen, Yundai, Lip, Gregory YH, Guo, Yutao, Lip, Gregory YH ORCID: 0000-0002-7566-1626, Lane, Deirdre A ORCID: 0000-0002-5604-9378, Chen, Yundai, Wang, Liming, Eckstein, Jens, Thomas, G Neil, Tong, Liu, Mei, Feng, Xuejun, Liu, Xiaoming, Li, Zhaoliang, Shan, Xiangming, Shi, Wei, Zhang, Yunli, Xing, Jing, Wen, Fan, Wu, Sitong, Yang, Xiaoqing, Jin, Bo, Yang, Xiaojuan, Bai, Yuting, Jiang, Yangxia, Liu, Yingying, Song, Zhongju, Tan, Li, Yang, Tianzhu, Luan, Chunfeng, Niu, Lili, Zhang, Shuyan, Li, Zulu, Wang, Bing, Xv, Liming, Liu, Yuanzhe, Jin, Yunlong, Xia, Xiaohong, Chen, Fang, Wu, Lina, Zhong, Yihong, Sun, Shujie, Jia, Jing, Li, Nan, Li, Shijun, Li, Huixia, Liu, Rong, Li, Fan, Liu, Qingfeng, Ge, Tianyun, Guan, Yuan, Wen, Xin, Li, Yan, Ren, Xiaoping, Chen, Ronghua, Chen, Yun, Shi, Yulan, Zhao, Haili, Shi, Yujie, Zhao, Quanchun, Wang, Weidong, Sun, Lin, Wei, Chan, Esther, Guangliang, Shan, Chen, Yao, Wei, Zong, Dandi, Chen, Xiang, Han, Anding, Xu, Xiaohan, Fan, Ziqiang, Yu, Xiang, Gu and Fulin, Ge (2020) Mobile Health Technology to Improve Care for Patients With Atrial Fibrillation. Journal of the American College of Cardiology, 75 (13). pp. 1523-1534.

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Abstract

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).

Item Type:	Article
Uncontrolled Keywords:	adverse events, atrial fibrillation, integrated care, mobile health
Depositing User:	Symplectic Admin
Date Deposited:	03 Apr 2020 10:31
Last Modified:	18 Jan 2023 23:56
DOI:	10.1016/j.jacc.2020.01.052
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3081709