Mobile health-technology integrated care in elderly atrial fibrillation patients: a report from the mAFA-II randomized clinical trial

Abstract

Abstract Background The prospective Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) randomized trial demonstrated the efficacy of a mobile health (mHealth) technology implemented “Atrial fibrillation Better Care” (ABC) pathway approach (mAFA intervention) for holistic or integrated care management in reducing the risk of adverse events in in patients with atrial fibrillation (AF). Whether these benefits also apply to elderly patients (who may be less adoptive of mHealth approaches) is unclear. Purpose In this ancillary analysis of the mAFA-II trial, we evaluated the effect of the mAFA intervention among elderly AF patients (age ≥75 years). Methods The mAFA-II trial enrolled adults AF patients across 40 centres in China between June 1, 2018 and August 16, 2019. The main outcome was the composite outcome of stroke or thromboembolism, all-cause death, and rehospitalization. Effect of the mAFA intervention was assessed through Cox proportional hazard models after the adjustment for baseline risk factors and cluster effect. We also assessed the interaction between age and the mAFA intervention effect on the main trial population. Results In this analysis, 1,163 elderly AF patients (mean age: 82.6±5.3 years, 43.1% females) were included, of which 520 were allocated to mAFA intervention and 643 to usual care. The mAFA intervention was associated with a significant reduction of the composite outcome (adjusted hazard ratio [aHR]: 0.58, 95% CI: 0.35–0.97) and rehospitalizations alone (aHR: 0.47, 95% CI: 0.24–0.91). A significant interaction between age and mAFA allocation group was observed for both the composite outcome (p=0.002; Figure 1, Panel A) and rehospitalization alone (p=0.015; Figure 1, Panel B), with the beneficial effect of the mAFA intervention decreasing with increasingly higher age, particularly at age ≥80 years old. Conclusions A mHealth-technology implemented ABC pathway is effective in reducing adverse clinical events in older AF patients aged ≥75 years old. The benefits obtained with mAFA intervention were attenuated at extreme ages, especially in those aged ≥80 years old. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): This research was funded by the National Natural Science Foundation of China 82170309). This study was an investigator-initiated project, with limited funding by independent research and educational grants.