Mobile health technology integrated care in atrial fibrillation patients with diabetes mellitus in China: A subgroup analysis of the mAFA‐II cluster randomized clinical trial

Abstract

BackgroundThe Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA‐II) prospective randomized trial showed the efficacy of a mobile health (mHealth) implemented ‘Atrial fibrillation Better Care’ (ABC) pathway for the integrated care management of patients with atrial fibrillation (AF). In this ancillary analysis, we evaluated the effect of mAFA intervention according to the history of diabetes mellitus (DM).MethodsThe mAFA‐II trial enrolled 3324 AF patients across 40 centres in China, between June 2018 and August 2019. In this analysis, we assessed the interaction between history of DM and the effect of mAFA intervention on the risk of the primary composite outcome of stroke, thromboembolism, all‐cause death and rehospitalizations. Results were expressed as adjusted hazard ratio (aHR) and 95% confidence intervals (95%CI). The effect of mAFA intervention on exploratory secondary outcomes was also assessed.ResultsOverall, 747 (22.5%) patients had DM (mean age: 72.7 ± 12.3, 39.6% females; 381 allocated to mAFA intervention). mAFA intervention was associated with a significant risk reduction for the primary composite outcome both in patients with and without DM (aHR [95%CI]: .36 [.18–.73] and .37 [.23–.61], respectively, p for interaction = .941). A significant interaction was found only for the composite of recurrent AF, heart failure and acute coronary syndromes (pint =.025), with lower effect of mAFA intervention in patients with DM.ConclusionsA mHealth‐technology implemented ABC pathway showed a consistent effect in reducing the risk of the primary composite outcome in AF patients with and without DM.Trial RegistrationWHO International Clinical Trials Registry Platform (ICTRP) Registration number: ChiCTR‐OOC‐17014138.

Adverse Events and Clinical Correlates in Asian Patients with Atrial Fibrillation and Diabetes Mellitus: A Report from Asia Pacific Heart Rhythm Society Atrial Fibrillation Registry

“…The most recent European and APHRS guidelines for AF management [ 27 , 28 ] advocate the integrated ABC pathway, whereby the pillars of AF management include Avoiding stroke with Anticoagulation; Better management of the symptoms patient-centered symptom-directed decisions on rate or rhythm control; and Cardiovascular risk factor optimization and lifestyle changes. Adherence to the ABC pathway has been associated with improved outcomes, with lower risks of death, stroke, major bleeding and hospitalizations [ 29 , 30 , 31 , 32 ]; benefits of the ABC pathway were also observed in patients with AF and DM [ 33 ] including a post-hoc analysis of the mAFA-II cluster randomized trial, which shows similar benefit of a mobile health-implemented ABC pathway in reducing the risk of the primary outcome of death, stroke, thromboembolism and rehospitalization in patients with and without DM [ 34 ].…”