The Effects of Implementing a Mobile Health–Technology Supported Pathway on Atrial Fibrillation–Related Adverse Events Among Patients With Multimorbidity
Key result
mHealth technology-supported integrated care (ABC pathway) significantly reduced the composite of stroke, death, and rehospitalization compared with usual care (HR 0.37; 95% CI 0.26-0.53; P<.001).
Why the study?
Multimorbidity is common in older patients with AF, but the impact of integrated or holistic care based on the ABC pathway on clinical outcomes in this population is uncertain.
Does integrated care supported by mHealth technology implementing the ABC pathway reduce the composite of stroke/thromboembolism, all-cause death, and rehospitalization in adult patients with atrial fibrillation and multimorbidity?
Population
1890 adult patients with AF and multimorbidity across 40 centers in China
Comparison
mHealth technology-supported integrated care (ABC pathway) vs usual care
Design
Prespecified ancillary analysis of an extended follow-up cluster randomized trial
Follow-up
Mean 419 days (intervention) and 457 days (usual care)
Authors
Discussion
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Member takes
Implication
Supports mHealth-supported ABC pathway adoption in multimorbid AF; extends integrated care evidence to this high-risk group.
Key Points
- To assess whether implementing an integrated Atrial Fibrillation Better Care (ABC) pathway supported by mobile health technology reduces adverse clinical events in patients with atrial fibrillation and multimorbidity.
- Prespecified ancillary analysis of the mAFA-II cluster randomized trial conducted across 40 centers in China between June 2018 and April 2021 (ICTRP: ChiCTR-OOC-17014138).
- Enrolled 1890 adults with atrial fibrillation and multimorbidity (≥2 chronic conditions), comparing mHealth-supported integrated care (n = 833; mean age 72.0 years; mean follow-up 419 days) to usual care (n = 1057; mean age 72.8 years; mean follow-up 457 days).
- Evaluated primary composite outcomes using Cox proportional hazards modeling adjusted for cluster effects and baseline risk factors.
- The mobile health intervention significantly reduced the primary composite outcome of stroke or thromboembolism, all-cause death, and rehospitalization compared to usual care (HR, 0.37; 95% CI, 0.26–0.53; P < .001).
- Rehospitalizations alone were significantly lower in the intervention group compared to usual care (HR, 0.42; 95% CI, 0.27–0.64; P < .001).
- Rates of acute coronary syndrome, heart failure, and uncontrolled blood pressure occurred in 3.2% (27/833) of intervention participants versus 13.7% (145/1057) receiving usual care (HR, 0.29; 95% CI, 0.19–0.45; P < .001).
Study Design
Type
RCT (n=1,890)
Randomization
Cluster randomized
Multicenter
Yes
Structured PICO
Does integrated care supported by mHealth technology implementing the ABC pathway reduce the composite of stroke/thromboembolism, all-cause death, and rehospitalization in adult patients with atrial fibrillation and multimorbidity?
P
Population
1,890 adult patients with atrial fibrillation and multimorbidity across 40 centers in China, followed for a mean of 419 to 457 days.
I
Intervention
Integrated care supported by mHealth technology (mAFA intervention) implementing the Atrial Fibrillation Better Care (ABC) pathway (A: anticoagulation/avoid stroke; B: better symptom control; C: cardiovascular disease and comorbidity management).
C
Comparator
Usual care.
O
Outcome
Composite outcome of stroke or thromboembolism, all-cause death, and rehospitalization.composite
Main Result
Hazard Ratio: 0.37 (95% CI 0.26–0.53)
p-value: p=<.001
Implementation of an mHealth-supported integrated care pathway (ABC pathway) significantly reduces adverse clinical events, including death and rehospitalization, in older patients with atrial fibrillation and multimorbidity.
Cite This Study
Yao et al. (2021) conducted an RCT in Atrial fibrillation with multimorbidity (n=1,890). Integrated care supported by mHealth technology (ABC pathway) vs. Usual care was evaluated on Composite outcome of stroke or thromboembolism, all-cause death, and rehospitalization (HR 0.37, 95% CI 0.26-0.53, p=<.001). mHealth technology-supported integrated care (ABC pathway) significantly reduced the composite of stroke, death, and rehospitalization compared with usual care (HR 0.37; 95% CI 0.26-0.53; P<.001).