Key result
mAFA intervention cuts major events ~42% versus usual care in AF patients ≥75 years.
Why the study?
Although the mAFA-II trial demonstrated that a mobile health-implemented ABC pathway reduced adverse events in AF, whether these benefits apply to older patients remained unclear.
Does a mobile health technology-implemented 'Atrial fibrillation Better Care' pathway reduce the composite of ischemic stroke, thromboembolism, all-cause death, and rehospitalisation in older atrial fibrillation patients (≥75 years)?
RCT (n=1,163)
randomised
Yes
Does a mobile health technology-implemented 'Atrial fibrillation Better Care' pathway reduce the composite of ischemic stroke, thromboembolism, all-cause death, and rehospitalisation in older atrial fibrillation patients (≥75 years)?
Hazard Ratio: 0.58 (95% CI 0.35–0.97)
A mobile health technology-implemented care pathway significantly reduces adverse clinical outcomes in older atrial fibrillation patients, though the benefits attenuate at extreme ages (≥80 years).
Supports mAFA adoption in AF patients ≥75 years; extends integrated care evidence to older adults.
BACKGROUND: The Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) randomised trial demonstrated the efficacy of a mobile health (mHealth) technology-implemented 'Atrial fibrillation Better Care' (ABC) pathway-approach (mAFA intervention) in reducing the risk of adverse events in patients with atrial fibrillation (AF). Whether these benefits also apply to older patients is unclear. In this ancillary analysis, we evaluated the effect of mAFA intervention among older AF patients. METHODS: The mAFA-II trial enrolled adult AF patients across 40 centres in China. For this analysis, we defined older patients as those aged ≥75 years. Primary outcome was the composite of ischemic stroke or thromboembolism, all-cause death and rehospitalisation. The effect of mAFA intervention was assessed through multivariable Cox-regression models. We also evaluated the interaction between age and effect of the mAFA intervention in the main trial population. RESULTS: In this analysis, we included 1,163 AF patients ≥75 years (mean age: 82.6 ± 5.3 years, 43.1% females); 520 were allocated to mAFA intervention, 643 to usual care. mAFA intervention was associated with a significant reduction of the primary composite outcome (adjusted hazard ratio [aHR]: 0.58, 95% confidence interval [CI]: 0.35-0.97) and rehospitalisations alone (aHR: 0.47, 95%CI: 0.24-0.91). Significant interaction between age and mAFA intervention effect was observed for both the composite outcome (P = 0.002) and rehospitalisation alone (P = 0.015), with the effect decreasing as age increased, particularly among patients ≥80 years old. CONCLUSIONS: A mHealth technology-implemented ABC pathway is effective in reducing adverse clinical outcomes in older AF patients. The benefits obtained with mAFA intervention were attenuated at extreme ages.
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Guo et al. (2022) conducted an RCT in atrial fibrillation (n=1,163). mAFA intervention (mHealth technology-implemented ABC pathway) vs. usual care was evaluated on composite of ischemic stroke or thromboembolism, all-cause death and rehospitalisation (aHR 0.58, 95% CI 0.35-0.97). The mAFA intervention significantly reduced the composite of ischemic stroke, thromboembolism, death, and rehospitalisation in AF patients ≥75 years (aHR 0.58; 95% CI 0.35-0.97).
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