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      Mobile health-technology integrated care in secondary prevention atrial fibrillation patients: a post-hoc analysis from the mAFA-II randomized clinical trial

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          Abstract

          AF patients with history of thromboembolic events are at higher risk of thromboembolic recurrences, despite appropriate antithrombotic treatment. We aimed to evaluate the effect of mobile health (mHealth) technology-implemented ‘Atrial fibrillation Better Care’ (ABC) pathway approach (mAFA intervention) in secondary prevention AF patients. The Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) cluster randomized trial enrolled adult AF patients across 40 centers in China. The main outcome was the composite outcome of stroke or thromboembolism, all-cause death, and rehospitalization. Using Inverse Probability of Treatment Weighting (IPTW), we evaluated the effect of the mAFA intervention in patients with and without prior history of thromboembolic events (i.e., ischemic stroke or thromboembolism). Among the 3324 patients enrolled in the trial, 496 (14.9%, mean age: 75.1 ± 11.4 years, 35.9% females) had a previous episode of thromboembolic event. No significant interaction was observed for the effect of mAFA intervention in patients with vs. without history of thromboembolic events [Hazard ratio, (HR): 0.38, 95% confidence interval (CI):0.18–0.80 vs. HR 0.55, 95% CI 0.17–1.76, p for interaction = 0.587); however, a trend towards lower efficacy of mAFA intervention among AF patients in secondary prevention was observed for secondary outcomes, with significant interaction for bleeding events ( p = 0.034) and the composite of cardiovascular events ( p = 0.015). A mHealth-technology-implemented ABC pathway provided generally consistent reduction of the risk of primary outcome in both primary and secondary prevention AF patients. Secondary prevention patients may require further specific approaches to improve clinical outcomes such as bleeding and cardiovascular events.

          Trial registration: WHO International Clinical Trials Registry Platform (ICTRP) Registration number ChiCTR-OOC-17014138.

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          Most cited references39

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          (2020)
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            Atrial fibrillation as an independent risk factor for stroke: the Framingham Study

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              Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060.

              Since atrial fibrillation (AF) is associated with increased risks of cardiovascular and cerebrovascular complications, estimations on the number of individuals with AF are relevant to healthcare planning. We aimed to project the number of individuals with AF in the Netherlands and in the European Union from 2000 to 2060. Age- and sex-specific AF prevalence estimates were obtained from the prospective community-based Rotterdam Study. Population projections for the Netherlands and the European Union were obtained from the European Union's statistics office. In the age stratum of 55-59 years, the prevalence of AF was 1.3% in men (95% CI: 0.4-3.6%) and 1.7% in women (95% CI: 0.7-4.0%). The prevalence of AF increased to 24.2% in men (95% CI: 18.5-30.7%), and 16.1% in women (95% CI: 13.1-19.4%), for those >85 years of age. This age- and sex-specific prevalence remained stable during the years of follow-up. Furthermore, we estimate that in the European Union, 8.8 million adults over 55 years had AF in 2010 (95% CI: 6.5-12.3 million). We project that this number will double by 2060 to 17.9 million (95% CI: 13.6-23.7 million) if the age- and sex-specific prevalence remains stable. We estimate that from 2010 to 2060, the number of adults 55 years and over with AF in the European Union will more than double. As AF is associated with significant morbidities and mortality, this increasing number of individuals with AF may have major public health implications.
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                Author and article information

                Contributors
                gregory.lip@liverpool.ac.uk
                Journal
                Intern Emerg Med
                Intern Emerg Med
                Internal and Emergency Medicine
                Springer International Publishing (Cham )
                1828-0447
                1970-9366
                16 March 2023
                16 March 2023
                2023
                : 18
                : 4
                : 1041-1048
                Affiliations
                [1 ]GRID grid.414252.4, ISNI 0000 0004 1761 8894, Department of Pulmonary Vessel and Thrombotic Disease, Sixth Medical Center, , Chinese PLA General Hospital, ; Beijing, People’s Republic of China
                [2 ]GRID grid.10025.36, ISNI 0000 0004 1936 8470, Liverpool Centre for Cardiovascular Sciences, , University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, ; William Henry Duncan Building, 6 West Derby St, Liverpool, L7 8TX UK
                [3 ]GRID grid.7841.a, Department of Translational and Precision Medicine, , Sapienza – University of Rome, ; Rome, Italy
                [4 ]GRID grid.410558.d, ISNI 0000 0001 0035 6670, Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, , University of Thessaly, ; Larissa, Greece
                [5 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, Department of Clinical Sciences and Community Health, , University of Milan, ; Milan, Italy
                [6 ]GRID grid.511455.1, Geriatric Unit, , IRCCS Istituti Clinici Scientifici Maugeri, ; Milan, Italy
                [7 ]GRID grid.7548.e, ISNI 0000000121697570, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, , University of Modena and Reggio Emilia, PoliclinicoDi Modena, ; Modena, Italy
                [8 ]GRID grid.5117.2, ISNI 0000 0001 0742 471X, Department of Clinical Medicine, , Aalborg University, ; Aalborg, Denmark
                Author information
                http://orcid.org/0000-0002-3788-8942
                Article
                3249
                10.1007/s11739-023-03249-0
                10326104
                36929347
                fea32664-74f3-41a8-8c9d-5ef543cf9393
                © The Author(s) 2023

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 14 November 2022
                : 26 February 2023
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 82170309
                Award Recipient :
                Categories
                Im - Original
                Custom metadata
                © Società Italiana di Medicina Interna (SIMI) 2023

                Emergency medicine & Trauma
                atrial fibrillation,integrated care,stroke,thromboembolism,outcomes
                Emergency medicine & Trauma
                atrial fibrillation, integrated care, stroke, thromboembolism, outcomes

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