Mobile health technology-supported atrial fibrillation screening and integrated care: A report from the mAFA-II trial Long-term Extension Cohort

Abstract

Highlights Amongst AF patients with long term use (≥1 year) of mHealth technology for optimising stroke prevention, symptom control and comorbidity management, there was a reduced risk for the composite outcome of 'ischaemic stroke/systemic thromboembolism, death, and rehospitalization’ in patients using App-based management based on the ABC (Atrial fibrillation Better Care) pathway. Rates of clinical outcomes (thromboembolism, bleeding events, recurrent atrial fibrillation and its symptoms, heart failure, and rehospitalization) were lower in patients allocated to mAF App intervention, compared with usual care. Over 70% of patients using the mAF App had adherence of approximately 70%, with the overall persistence of mAFA use being 91.7%.

Adherence to the ‘Atrial Fibrillation Better Care’ Pathway in Patients with Atrial Fibrillation: Impact on Clinical Outcomes—A Systematic Review and Meta-Analysis of 285,000 Patients

“…Our evidence that a longer observation is associated with a greater reduction in risk for all the outcomes corroborates the evidence for the effectiveness of the intervention, where there is a 'dose-response' effect, extending the evidence from the mAFA-II rial secondary analyses (31).…”

Clinical Factors Associated with Atrial Fibrillation Detection on Single-Time Point Screening Using a Hand-Held Single-Lead ECG Device

“…Moreover, a 12-lead ECG is required as the basis for a complete clinical evaluation [37]. More recently, a large number of devices, including wearables have been proposed for AF screening, but their appropriate use still needs to be clarified, also with the need for organizing referral for clinical evaluation in case of suspected or detected AF [16,35,38]. As a consequence of the disruptive effects of COVID-19 pandemic, screening for AF may become even more important in the next future.…”

Long-Term Effects of Apixaban Confirmed in the Open-Label Extension of AVERROES Trial

“…Indeed, the wellstructured, easy-to-use ABC holistic pathway (A: Avoid stroke; B: Better symptom management; C: Cardiovascular and other comorbidity risk reduction), should be implemented into daily practice for the management of all AF patients. 21,22 Figure 1. Risks of stroke/SE and major bleeding of patients who had been randomized to an NOAC during and after the end of double-blind phase, and those reported in the open-label extension period of RE-LY (RELY-ABLE) and AVERROES trials.…”

“…Indeed, the well-structured, easyto-use ABC holistic pathway (A: Avoid stroke; B: Better symptom management; C: Cardiovascular and other comorbidity risk reduction), should be implemented into daily practice for the management of all AF patients. 21,22…”