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Randomized Controlled Trial
. 2023 Jun;18(4):1041-1048.
doi: 10.1007/s11739-023-03249-0. Epub 2023 Mar 16.

Mobile health-technology integrated care in secondary prevention atrial fibrillation patients: a post-hoc analysis from the mAFA-II randomized clinical trial

Yutao Guo #  1   2 , Giulio Francesco Romiti #  2   3 , Dimitrios Sagris  2   4 , Marco Proietti  2   5   6 , Niccolò Bonini  2   7 , Hui Zhang  1 , Gregory Y H Lip  8   9   10 ; mAF-App II trial investigators
Affiliations
Randomized Controlled Trial

Mobile health-technology integrated care in secondary prevention atrial fibrillation patients: a post-hoc analysis from the mAFA-II randomized clinical trial

Yutao Guo et al. Intern Emerg Med. 2023 Jun.

Abstract

AF patients with history of thromboembolic events are at higher risk of thromboembolic recurrences, despite appropriate antithrombotic treatment. We aimed to evaluate the effect of mobile health (mHealth) technology-implemented 'Atrial fibrillation Better Care' (ABC) pathway approach (mAFA intervention) in secondary prevention AF patients. The Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) cluster randomized trial enrolled adult AF patients across 40 centers in China. The main outcome was the composite outcome of stroke or thromboembolism, all-cause death, and rehospitalization. Using Inverse Probability of Treatment Weighting (IPTW), we evaluated the effect of the mAFA intervention in patients with and without prior history of thromboembolic events (i.e., ischemic stroke or thromboembolism). Among the 3324 patients enrolled in the trial, 496 (14.9%, mean age: 75.1 ± 11.4 years, 35.9% females) had a previous episode of thromboembolic event. No significant interaction was observed for the effect of mAFA intervention in patients with vs. without history of thromboembolic events [Hazard ratio, (HR): 0.38, 95% confidence interval (CI):0.18-0.80 vs. HR 0.55, 95% CI 0.17-1.76, p for interaction = 0.587); however, a trend towards lower efficacy of mAFA intervention among AF patients in secondary prevention was observed for secondary outcomes, with significant interaction for bleeding events (p = 0.034) and the composite of cardiovascular events (p = 0.015). A mHealth-technology-implemented ABC pathway provided generally consistent reduction of the risk of primary outcome in both primary and secondary prevention AF patients. Secondary prevention patients may require further specific approaches to improve clinical outcomes such as bleeding and cardiovascular events.Trial registration: WHO International Clinical Trials Registry Platform (ICTRP) Registration number ChiCTR-OOC-17014138.

Keywords: Atrial fibrillation; Integrated care; Outcomes; Stroke; Thromboembolism.

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Conflict of interest statement

GYHL has been consultant and speaker for BMS/Pfizer, Boehringer Ingelheim and Daiichi-Sankyo. No fees are directly received personally. All the disclosures happened outside the submitted work. All other authors have nothing to declare.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Risk of major outcomes according to mAFA intervention in patients with vs. without history of thromboembolic events. CI confidence interval, HR Hazard ratio, IS Ischemic stroke, TE thromboembolism
See this image and copyright information in PMC

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