Department of Pulmonary Vessel and Thrombotic Disease, Sixth Medical Center, Chinese PLA General Hospital, Beijing, China.
Liverpool Centre for Cardiovascular Sciences at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
Age Ageing. 2022 Nov 2;51(11). doi: 10.1093/ageing/afac245.
The Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) randomised trial demonstrated the efficacy of a mobile health (mHealth) technology-implemented 'Atrial fibrillation Better Care' (ABC) pathway-approach (mAFA intervention) in reducing the risk of adverse events in patients with atrial fibrillation (AF). Whether these benefits also apply to older patients is unclear. In this ancillary analysis, we evaluated the effect of mAFA intervention among older AF patients.
The mAFA-II trial enrolled adult AF patients across 40 centres in China. For this analysis, we defined older patients as those aged ≥75 years. Primary outcome was the composite of ischemic stroke or thromboembolism, all-cause death and rehospitalisation. The effect of mAFA intervention was assessed through multivariable Cox-regression models. We also evaluated the interaction between age and effect of the mAFA intervention in the main trial population.
In this analysis, we included 1,163 AF patients ≥75 years (mean age: 82.6 ± 5.3 years, 43.1% females); 520 were allocated to mAFA intervention, 643 to usual care. mAFA intervention was associated with a significant reduction of the primary composite outcome (adjusted hazard ratio [aHR]: 0.58, 95% confidence interval [CI]: 0.35-0.97) and rehospitalisations alone (aHR: 0.47, 95%CI: 0.24-0.91). Significant interaction between age and mAFA intervention effect was observed for both the composite outcome (P = 0.002) and rehospitalisation alone (P = 0.015), with the effect decreasing as age increased, particularly among patients ≥80 years old.
A mHealth technology-implemented ABC pathway is effective in reducing adverse clinical outcomes in older AF patients. The benefits obtained with mAFA intervention were attenuated at extreme ages.
移动医疗技术改善房颤筛查和优化综合管理（mAFA-II）随机试验证明，移动医疗（mHealth）技术实施的“房颤更好护理”（ABC）途径方法（mAFA 干预）可降低房颤（AF）患者不良事件的风险。这些益处是否也适用于老年患者尚不清楚。在这项辅助分析中，我们评估了 mAFA 干预对老年 AF 患者的影响。
mAFA-II 试验在中国 40 个中心招募了成年 AF 患者。在这项分析中，我们将年龄≥75 岁的患者定义为老年患者。主要结局是缺血性卒中和血栓栓塞、全因死亡和再住院的复合结局。通过多变量 Cox 回归模型评估 mAFA 干预的效果。我们还评估了年龄与 mAFA 干预在主要试验人群中的效果之间的相互作用。
在这项分析中，我们纳入了 1163 名年龄≥75 岁的 AF 患者（平均年龄：82.6±5.3 岁，43.1%为女性）；520 名患者被分配到 mAFA 干预组，643 名患者被分配到常规护理组。mAFA 干预与主要复合结局（调整后的危险比[aHR]：0.58，95%置信区间[CI]：0.35-0.97）和再住院治疗单独（aHR：0.47，95%CI：0.24-0.91）显著降低相关。年龄与 mAFA 干预效果之间存在显著的相互作用，无论是复合结局（P=0.002）还是再住院治疗单独（P=0.015），随着年龄的增加，效果降低，特别是≥80 岁的患者。
移动医疗技术实施的 ABC 途径可有效降低老年 AF 患者的不良临床结局。mAFA 干预的获益在极端年龄时减弱。
