Mobile health technology integrated care in older atrial fibrillation patients: a subgroup analysis of the mAFA-II randomised clinical trial
Yutao Guo, Giulio Francesco Romiti, Marco Proietti, Niccolò Bonini, Hui Zhang, Gregory Y.H. Lip, the mAF-App II Trial Investigators, Deirdre A. Lane, Yundai Chen, Liming Wang, Jens Eckstein, G. Neil Thomas, Tong Liu, Mei Feng, Liu Xuejun, Xiaoming Li, Shan Zhaoliang, Shi Xiangming, Wei Zhang, Xing Yunli, Jing Wen, Fan Wu, Yang Sitong, Xiaoqing Jin, Yang Bo, Bai Xiao-juan, Jiang Yuting, Liu Yangxia, Yingying Song, Tan Zhongju, Yang Li, Luan Tianzhu, Niu Chunfeng, Zhang Lili, Shuyan Li, Wang Zulu, Xv Bing, Liu Liming, Jin Yuanzhe, Yunlong Xia, Chen Xiaohong, Fang Wu, Zhong Lina, Sun Yihong, Jia Shujie, Li Jing, Nan Li, Shijun Li, Liu Huixia, Rong Li, Liu Fan, Ge Qingfeng, Guan Tianyun, Wen Yuan, Li Xin, Yan Ren, Chen Xiaoping, Chen Ronghua, Shi Yun, Yulan Zhao, Shi Haili, Yujie Zhao, Wang Quan-chun, Sun Weidong, Wei Lin
Abstract
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.