Background: The mAFA-II trial is a prospective cluster randomized trial which showed that compared to usual care, integrated care in patients with atrial fibrillation (AF) using mobile health (mHealth) technology implementing the ABC pathway reduced adverse outcome. Multimorbidity (MM) is common in elderly AF patients and the impact of integrated care on outcomes is uncertain.

Aims: To evaluate whether implementation of mHealth technology-supported integrated ABC Pathway, would reduce AF-related adverse events in patients with MM.

Methods: We analysed the MM subset of AF patients (≥2 comorbidities of hypertension, coronary artery disease, heart failure (HF), cardiomyopathy, peripheral arterial disease, diabetes mellitus, liver/renal dysfunction, pulmonary disease, prior stroke) participating in the mAFA II trial between June 1, 2018 and April 1, 2020 across 40 centers in China. 

Results: There were 833 patients (mean age 72.0 years, 33.4% female) with MM allocated to intervention (ABC pathway) with mean follow-up of 419 (SD 257) days; and 1057 patients (mean age 72.8 years, 41.9% female) with MM were allocated to usual care with mean follow-up of 457 (SD 154) days. Compared to usual care, the composite outcome of stroke/thromboembolism, all-cause death and rehospitalization was significantly reduced with the mAFA intervention (Hazard Ratio, HR, 0.37, 95% CI: 0.26-0.53, p<0.001). For the A criterion, rates of thromboembolism were lower with mAFA intervention (0.5% vs 2.9%; HR 0.17, 95% CI: 0.05-0.51, P = 0.002), with no difference in bleeding. For the C criterion, rates of the occurrence of acute coronary syndrome, HF, uncontrolled blood pressure, etc. during the follow-up were lower with mAFA intervention (3.2% vs. 13.7%, HR 0.29, 95% CI: 0.19-0.45, P <0.001).  [Figure].Hazard Ratios of clinical events with the ABC pathway (and its components), in relation to multimorbidity, adjusting for baseline risk factors. * mAFA: mobile atrial fibrillation application. HRs: hazard ratio. IS: ischemic stroke. TE: thromboembolism

Conclusions: mHealth technology based integrated care approach, facilitating the ABC pathway, reducing the clinical adverse events in elderly AF patients with multimorbidity, compared to usual care.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/improving-outcomes-with-integrated-care-of-patients-with-atrial-fibrillation-and-multimorbidity-using-mobile-health-technology-a-report-from-the-mafa-ii-trial/