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Medically reviewed by Dr. Shani S. Saks, D.O. on August 2, 2023

A mobile health technology intervention consistently reduced primary composite outcomes comprising all-cause death, systemic embolism, rehospitalization, and ischemic stroke for primary and secondary prevention.

The risk of thromboembolic recurrences is higher in atrial fibrillation (AF) patients with a previous history of thromboembolic events, regardless of the provision of antithrombotic treatment. This study, published in the journal Internal and Emergency Medicine, investigated the outcomes of mobile health technology-implemented ‘Atrial fibrillation Better Care’ (ABC) pathway approach (mAFA) in the secondary prevention of thromboembolic recurrences in AF patients.

Study Characteristics

A total of 3324 Chinese patients were enrolled, of which 1678 patients and 1646 patients were allocated to usual care and mAFA intervention groups, respectively. Of these patients, 496 had a history of a thromboembolic event at baseline.

Effect of mAFA Intervention in Patients With a Preceding Thromboembolic Event

In the mAFA intervention and usual care groups, 232 and 264 patients had a preceding thromboembolic event, respectively. Patients who were allocated to the mAFA intervention group had greater female representation, a higher prevalence of heart failure history, and a higher CHA2DS2-VASc clinical risk score. Patients in the mAFA intervention group had more frequent use of clopidogrel.

Effect of mAFA Intervention in Patients Without a Preceding Thromboembolic Event

Of the patients without a history of thromboembolism, 1414 (50%) were placed in the mAFA intervention group and 1414 were placed in the usual care group. The mAFA group subjects were younger,  less likely to be female, and had a lower prevalence of heart failure, renal dysfunction, anemia, and coronary artery disease. These patients were more frequently given non-vitamin K antagonist oral anticoagulants (NOACs) treatment.

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mAFA Intervention and Risk of Major Outcomes

There was no statistically significant interaction between the risk of primary composite outcome and mAFA intervention in those with and without a history of thromboembolism. Regarding the secondary outcomes, there was a significant association between thromboembolism history and mAFA intervention effect for bleeding events, acute coronary syndromes, recurrent AF, and heart failure.

Source:

Guo, Y., Romiti, G. F., Sagris, D., Proietti, M., Bonini, N., Zhang, H., & Lip, G. Y. (2023). Mobile health-technology integrated care in secondary prevention atrial fibrillation patients: a post-hoc analysis from the mAFA-II randomized clinical trial. Internal and Emergency Medicine, 18(4), 1041–1048. https://doi.org/10.1007/s11739-023-03249-0