Guo Yutao, Romiti Giulio Francesco, Corica Bernadette, Proietti Marco, Bonini Niccolò, Zhang Hui, Lip Gregory Yh
Department of Pulmonary Vessel and Thrombotic Disease, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy.
Eur J Intern Med. 2023 Jan;107:46-51. doi: 10.1016/j.ejim.2022.11.002. Epub 2022 Nov 5.
To assess the effect of mobile health (mHealth) technology-implemented 'Atrial fibrillation Better Care' (ABC) pathway-approach (mAFA intervention) in AF patients with Heart Failure (HF).
From the Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) cluster randomized trial, we evaluated the effect of mAFA intervention on the risk of major outcomes in patients with HF using Inverse Probability of Treatment Weighting. Primary outcome was the composite outcome of stroke/thromboembolism, all-cause death, and rehospitalization. The effect of mAFA and the interaction with HF at baseline was assessed through Cox-regressions.
Among the 3,324 patients originally enrolled in the trial, 714 (21.5%; mean age: 72.7±13.1 years; 39.9% females) had HF. The effect of mAFA intervention on the primary outcome was consistent in patients with and without HF (Hazard Ratio, (HR): 0.59, 95% Confidence Interval (CI): 0.29-1.22 vs. HR: 0.40, 95%CI: 0.21-0.76, p for interaction=0.438); similar findings were found for rehospitalisations and bleeding events. A trend towards lower efficacy of mAFA in HF patients was observed for all-cause death, while the risk of the composite outcome of 'recurrent AF, HF and acute coronary syndrome' was higher among AF-HF patients allocated to mAFA (p for interaction: <0.001).
A mHealth-technology implemented ABC pathway provides consistent effects on the risks of primary outcome, rehospitalisation and bleeding, in AF patients both with and without HF. However, AF-HF patients may need tailored approaches to improve their overall prognosis, specifically to reduce the risk of recurrent AF, HF and acute coronary syndrome.
评估移动健康（mHealth）技术实施的“房颤优化照护”（ABC）路径方法（mAFA干预）对心力衰竭（HF）合并房颤患者的影响。
从“用于改善房颤筛查和优化综合照护的移动健康技术”（mAFA-II）整群随机试验中，我们采用治疗权重逆概率法评估了mAFA干预对HF患者主要结局风险的影响。主要结局是卒中/血栓栓塞、全因死亡和再住院的复合结局。通过Cox回归评估mAFA的效果以及与基线时HF的相互作用。
在最初纳入试验的3324例患者中，714例（21.5%；平均年龄：72.7±13.1岁；39.9%为女性）患有HF。mAFA干预对主要结局的影响在有HF和无HF的患者中是一致的（风险比，（HR）：0.59，95%置信区间（CI）：0.29 - 1.22，与之相比HR：0.40，95%CI：0.21 - 0.76，交互作用p值 = 0.438）；再住院和出血事件也有类似发现。在全因死亡方面，观察到mAFA在HF患者中的疗效有降低趋势，而在分配到mAFA的房颤合并HF患者中，“复发性房颤、HF和急性冠状动脉综合征”复合结局的风险更高（交互作用p值：<0.001）。
移动健康技术实施的ABC路径对有HF和无HF的房颤患者的主要结局、再住院和出血风险具有一致的影响。然而，房颤合并HF患者可能需要量身定制的方法来改善其总体预后，特别是降低复发性房颤、HF和急性冠状动脉综合征的风险。
