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.
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.
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.
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