作者
Yutao Guo,Deirdre A. Lane,Limin Wang,Hui Zhang,Hao Wang,Wei Zhang,Jing Wen,Yunli Xing,Fang Wu,Yunlong Xia,Tong Liu,Fan Wu,Zhaoguang Liang,Fan Liu,Yujie Zhao,Rong Li,Xin Li,Lili Zhang,Jun Guo,Girvan Burnside,Yundai Chen,Gregory Y.H. Lip,Yutao Guo,Gregory Y.H. Lip,Deirdre A. Lane,Yundai Chen,Liming Wang,Jens Eckstein,G. Neil Thomas,Tong Liu,Mei Feng,Xuejun Liu,Xiaoming Li,Zhaoliang Shan,Shi Xiangming,Wei Zhang,Yunli Xing,Jing Wen,Fan Wu,Yang Sitong,Xiaoqing Jin,Bo Yang,Bai Xiao-juan,Yuting Jiang,Liu Yangxia,Yingying Song,Tan Zhongju,Yang Li,Tianzhu Luan,Niu Chunfeng,Lili Zhang,Shuyan Li,Zulu Wang,Xinyu Bing,Liu Liming,Yuan‐Zhe Jin,Xia Y,Xiaohong Chen,Fang Wu,Lina Zhong,Yaxun Sun,Jia Shujie,Jing Li,Nan Li,Shijun Li,Huixia Liu,Rong Li,Fan Liu,Ge Qingfeng,Guan Tianyun,Yuan Wen,Li Xin,Yan Ren,Xiaoping Chen,Ronghua Chen,Shi Yun,Yulan Zhao,Haili Shi,Yujie Zhao,Wang Quan-chun,Sun Weidong,Wei‐Che Lin,Esther W. Chan,Shan Guang-liang,Yao Chen,Wei Zong,Dandi Chen,Han Xiang,Anding Xu,Fan Xiaohan,YU Ziqiang,Gu Xiang,Ge Fulin
摘要
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. 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. 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. 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). 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).