Mobile health-technology integrated care in atrial fibrillation patients with heart failure: A report from the mAFA-II randomized clinical trial

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

“…In this scenario, the ABC pathway represents a pragmatic—yet comprehensive—approach to streamline a holistic bundle of care, able to improve the treatment patterns in AF‐DM patients, and to ameliorate their prognosis, as shown in our analysis. Our results are consistent with other previous analyses on the mAFA‐II trial, which showed how the mAFA intervention was effective in reducing the risk of adverse events in other high‐risk subgroups of patients, such as the elderly and those with history of heart failure 32,33 …”

Atrial fibrillation: epidemiology, screening and digital health

“…A total of 33 publications were considered relevant. Of those, 14 publications reported on integrated e-health enhanced management of AF, 47 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 5 on remote AF management platforms, 65 , 66 , 67 , 68 , 69 3 publications on mHealth-based heart rate/rhythm monitoring, 70 , 71 , 72 6 publications on mHealth supported patient self-care and medication adherence tools 73 , 74 , 75 , 76 , 77 , 78 and 5 publications reported on clinical decision making support tools. 79 , 80 , 81 , 82 , 83 …”

“… 59 China Cost benefit analysis NA NA NA 30 y Costs (IC vs UC): US $35,691 vs US $34,601 QALY gain: 7.2749 vs 7.2019 ICER below WTP: US $14,936 vs US $33,438 per QALY Guo et al. 55 China RCT 360 (IC) 354 (UC) 73 ± 13 73 ± 14 45% 35% 12 months Death/ischemic stroke/systemic thromboembolism, rehospitalization (IC vs UC): HR 0.40, 95% CI 0.21–0.76 (no HF) RAF/HF/MI: HR 0.26, 95% CI 0.14–0.48 (no HF) HR 1.99, 95% CI 1.08–3.69 (HF) Gawalko et al. 47 Europe RC TeleCheckAF infrastructure AF education Heart rhythm monitoring Symptom tracker Teleconsultations 1480 64 (55–71 38% NA Patient experience: ease to use (94%), safe feeling (74%), willingness to use in the future (58%) Physician experience: no problems with cloud access (91%), patient recruitment (91%), quality of recordings (91%), patient compliance with heart rate/rhythm monitoring (83%) number and time to include patients, independent of the centers' mHealth experience Retrospective design Differences in mHealth reimbursement system Course of the study during the pandemic Hermans et al.…”

“…Results from multiple mAFA-II trial analyses showed that the mAFA intervention (vs usual care) improved patient knowledge on AF, quality of life 52 and oral anticoagulation adherence, 52 , 56 as well as reduced the risk of bleeding events (2.1% vs 4.3%) 56 and composite outcome of recurrent AF, heart failure and acute coronary syndrome, however, only in patients without heart failure (HR 0.26, 95% CI 0.14–0.48). 55 The mAFA intervention decreased rate of the composite primary endpoint of ischemic stroke/systemic thromboembolism, all-cause death and re-hospitalization over a mean of 286 days (HR 0.39, 95% CI 0.22–0.67) 53 and it reduced the rate even more in the long-term follow-up (mean 697 days; HR 0.18, 95%, CI 0.13–0.25) 54 compared to the usual care group. This superior effect held true for patients with multimorbidity 57 and both in males and females.…”

2024 Chinese Expert Consensus Guidelines on the Diagnosis and Treatment of Atrial Fibrillation in the Elderly, Endorsed by Geriatric Society of Chinese Medical Association (Cardiovascular Group) and Chinese Society of Geriatric Health Medicine (Cardiovascular Branch): Executive Summary

“…33 In the mAFA-II randomised trial, smart technology facilitated ABC pathway (mobile Atrial Fibrillation, mAFA) reduced clinical adverse in the elderly patients with AF, reducing the composite endpoints of all-cause death, thromboembolism and rehospitalization in the elderly patients aged over 75 years, or HF, diabetes, prior thromboembolism, or with multiple morbidity ( Figure 4). [34][35][36][37][38] In a systematic review and meta-analysis, adherence to the ABC pathway was associated with a reduction in mortality, stroke and bleeding. 39 The potential cost-effective use of streamlining and integrating care via the Atrial fibrillation Better Care (ABC) pathway for AF has been reported.…”