TY - JOUR
T1 - Mobile health technology-supported atrial fibrillation screening and integrated care
T2 - A report from the mAFA-II trial Long-term Extension Cohort
AU - Guo, Yutao
AU - Guo, Jun
AU - Shi, Xiangmin
AU - Yao, Yuan
AU - Sun, Yihong
AU - Xia, Yunlong
AU - Yu, Bo
AU - Liu, Tong
AU - Chen, Yundai
AU - Lip, Gregory Y.H.
AU - mAF-App II Trial investigators
N1 - Copyright © 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - BACKGROUND: In the mobile Atrial Fibrillation App (mAFA)-II trial, the use of mobile health (mHealth) technology, incorporating AF screening and integrated management strategy, was associated with improved short-term clinical outcomes. The aim of this study was to report adherence/persistence and long term (≥1 year) clinical outcomes of the mAFA-II trial, with mHealth-supported optimised stroke prevention, symptom control and comorbidity management.METHODS: We studied an adult population screened for AF, where identified patients could enter a structured program of holistic and integrated care based on the ABC (Atrial fibrillation Better Care) pathway using mHealth with a mAFA intervention. In this cluster randomised trial, comparing mHeath intervention to usual care, the primary composite outcome was 'stroke/thromboembolism, all-cause death and rehospitalization'.RESULTS: The 1261 subjects (mean age 67.0 years, 38.0% female) who were followed up over one year (mean follow-up 687 (standard deviation, SD 191) days) in the intervention arm, had a lower risk of the composite outcome of 'ischaemic stroke/systemic thromboembolism, death, and rehospitalization' (hazard ratio, HR 0.18, 95% confidence interval, CI: 0.13-0.25, P < 0.001), compared to usual care (1212 subjects, mean age 70.1 years, 42.1% female). Of 842 patients using their smart devices for 'Better symptom management', 70.8% had good management adherence (monitoring time/follow-up since initial monitoring ≥ 70%), with the persistence of use of 91.7%.CONCLUSION: Amongst AF patients with long term use (≥1 year) of mHealth technology for optimising stroke prevention, symptom control and comorbidity management, adherence/persistence was good and associated with a reduction in adverse clinical outcomes.
AB - BACKGROUND: In the mobile Atrial Fibrillation App (mAFA)-II trial, the use of mobile health (mHealth) technology, incorporating AF screening and integrated management strategy, was associated with improved short-term clinical outcomes. The aim of this study was to report adherence/persistence and long term (≥1 year) clinical outcomes of the mAFA-II trial, with mHealth-supported optimised stroke prevention, symptom control and comorbidity management.METHODS: We studied an adult population screened for AF, where identified patients could enter a structured program of holistic and integrated care based on the ABC (Atrial fibrillation Better Care) pathway using mHealth with a mAFA intervention. In this cluster randomised trial, comparing mHeath intervention to usual care, the primary composite outcome was 'stroke/thromboembolism, all-cause death and rehospitalization'.RESULTS: The 1261 subjects (mean age 67.0 years, 38.0% female) who were followed up over one year (mean follow-up 687 (standard deviation, SD 191) days) in the intervention arm, had a lower risk of the composite outcome of 'ischaemic stroke/systemic thromboembolism, death, and rehospitalization' (hazard ratio, HR 0.18, 95% confidence interval, CI: 0.13-0.25, P < 0.001), compared to usual care (1212 subjects, mean age 70.1 years, 42.1% female). Of 842 patients using their smart devices for 'Better symptom management', 70.8% had good management adherence (monitoring time/follow-up since initial monitoring ≥ 70%), with the persistence of use of 91.7%.CONCLUSION: Amongst AF patients with long term use (≥1 year) of mHealth technology for optimising stroke prevention, symptom control and comorbidity management, adherence/persistence was good and associated with a reduction in adverse clinical outcomes.
KW - Atrial fibrillation
KW - Integrated care
KW - Screening
KW - Smart technology
UR - http://www.scopus.com/inward/record.url?scp=85092447497&partnerID=8YFLogxK
U2 - 10.1016/j.ejim.2020.09.024
DO - 10.1016/j.ejim.2020.09.024
M3 - Journal article
C2 - 33067121
AN - SCOPUS:85092447497
SN - 0953-6205
VL - 82
SP - 105
EP - 111
JO - European Journal of Internal Medicine
JF - European Journal of Internal Medicine
ER -