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Atrial Fibrillation Care Using Mobile Health Technology
Study Questions:
Are outcomes improved when mobile health technology is incorporated into the management of patients with atrial fibrillation (AF)?
Methods:
In this multicenter trial performed in China, 3,324 patients with AF were randomly assigned to either integrated care based on a mobile AF application capable of AF detection (mAFA, n = 1,646, mean age 67) or usual care (n = 1,678, mean age 70 years). The smart phone mAFA version used by physicians focused on risk score tools, guideline-based treatment recommendations focused on stroke prevention, symptom management, and comorbidity risk reduction. The mAFa also allowed rapid communication between physicians and patients. The primary outcome was a composite of stroke/thromboembolism, all-cause death, and rehospitalization. The mean duration of follow-up was 286 days.
Results:
The incidence of the primary outcome was significantly lower in the mAFA group (1.9%) than in the usual care group (6.0%). After adjustment for age and comorbidities, there was a 61% reduction in the primary outcome in the mAFA group. This was largely driven by a significantly lower rehospitalization rate in the mAFA group (1.2%) than in the usual care group (4.5%). There were not significant differences between the two groups in stroke/thromboembolism or all-cause death.
Conclusions:
Incorporation of mAFA into the care of patients with AF significantly reduces the rate of rehospitalizations.
Perspective:
AF detection devices that have become available for patient use have proven very useful for guiding recommendations for rate-control therapies, rhythm-control therapies, and anticoagulation. The present study presents strong evidence that the addition of AF management tools directed at both physicians and patients into a smart phone application can significantly lower the need for hospitalizations.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiovascular Care Team, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Biomedical Technology, Delivery of Health Care, Integrated, Hospitalization, Mobile Applications, Mobile Health Units, Outcome Assessment, Health Care, Risk Reduction Behavior, Stroke, Thromboembolism, Vascular Diseases
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