Telemedicine-based integrated management of atrial fibrillation in village clinics: a cluster randomized trial

IF 50 1区医学 Q1 BIOCHEMISTRY & MOLECULAR BIOLOGY Nature Medicine Pub Date : 2025-02-21 DOI:10.1038/s41591-025-03511-2

Ming Chu, Shimeng Zhang, Jinlong Gong, Shu Yang, Gang Yang, Xingxing Sun, Dan Wu, Yaodongqin Xia, Jincheng Jiao, Xiafeng Peng, Zhihang Peng, Li Hong, Zhirong Wang, Mingfang Li, Gregory Y. H. Lip, Minglong Chen, on behalf of the MIRACLE-AF Investigators

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Abstract

In rural China, where healthcare relies on village doctors (nonspecialized practitioners who work exclusively in their village clinics), delivering integrated atrial fibrillation (AF) management poses challenges. We developed a telemedicine-based, village doctor-led integrated care model and conducted a cluster randomized clinical trial to assess its efficacy compared to usual care. A total of 30 village clinics were randomly assigned (1:1) to the intervention or control group, with 1,039 village residents aged ≥65 years with AF (44.3% women) recruited. The primary outcome in stage 1 is adherence to integrated AF care at 12 months. In stage 2, the primary outcome is a composite of cardiovascular death, all strokes, heart failure or acute coronary syndrome hospitalization, and AF emergency visits over 36 months. Both primary outcomes were met. At 12 months, 33.1% in the telemedicine-based, village doctor-led care group and 8.7% in the usual care group met all criteria for integrated AF care (between-group difference, 24.4% (95% confidence interval (CI), 18.3–30.5%); P < 0.001). Over 34.0 months, 41.8% in the telemedicine-based, village doctor-led care group and 10.3% in the usual care group met all criteria for integrated AF care (P < 0.001). The rate of the composite cardiovascular event outcome was lower in the telemedicine-based, village doctor-led care group than in the usual care group (6.2% versus 9.6% per year; hazard ratio, 0.64 (95% CI, 0.50–0.82); P < 0.001). Our trial intervention by this telemedicine-based integrated care delivery model of AF care in rural villages demonstrates better adherence and improved clinical outcomes compared to usual care. ClinicalTrials.gov registration: NCT04622514 . A cluster randomized trial in China shows that telemedicine-based, village doctor-led delivery of integrated care reduced the occurrence of adverse cardiovascular events and hospitalizations in older adults with atrial fibrillation.

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基于远程医疗的乡村诊所房颤综合管理：一项聚类随机试验

在中国农村，医疗保健依赖于乡村医生（只在乡村诊所工作的非专业医生），提供房颤（AF）综合管理带来了挑战。我们开发了一种基于远程医疗、乡村医生主导的综合护理模式，并进行了一项随机临床试验，以评估其与常规护理相比的疗效。30个村卫生室按1:1的比例随机分为干预组和对照组，共招募1039名年龄≥65岁的AF村居民（44.3%为女性）。第一阶段的主要结局是在12个月时坚持房颤综合治疗。在第2阶段，主要结局是心血管死亡、所有中风、心力衰竭或急性冠状动脉综合征住院以及房颤急诊超过36个月。两项主要结果均得到满足。12个月时，以远程医疗为基础的村医主导护理组33.1%和常规护理组8.7%符合房颤综合护理的所有标准(组间差异为24.4%(95%可信区间（CI）， 18.3-30.5%)；P < 0.001)。34.0个月后，以远程医疗为基础的村医主导护理组41.8%和常规护理组10.3%的患者符合房颤综合护理的所有标准（P < 0.001）。在以远程医疗为基础的村医主导的护理组中，复合心血管事件转化率低于常规护理组(6.2% vs 9.6% /年；风险比，0.64 (95% CI, 0.50-0.82)；P < 0.001)。与常规护理相比，我们在农村采用这种基于远程医疗的房颤综合护理模式的试验干预显示出更好的依从性和改善的临床结果。ClinicalTrials.gov注册：NCT04622514。

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来源期刊

Nature Medicine 医学-生化与分子生物学

CiteScore

100.90

自引率

0.70%

发文量

525

审稿时长

1 months

期刊介绍： Nature Medicine is a monthly journal publishing original peer-reviewed research in all areas of medicine. The publication focuses on originality, timeliness, interdisciplinary interest, and the impact on improving human health. In addition to research articles, Nature Medicine also publishes commissioned content such as News, Reviews, and Perspectives. This content aims to provide context for the latest advances in translational and clinical research, reaching a wide audience of M.D. and Ph.D. readers. All editorial decisions for the journal are made by a team of full-time professional editors. Nature Medicine consider all types of clinical research, including: -Case-reports and small case series -Clinical trials, whether phase 1, 2, 3 or 4 -Observational studies -Meta-analyses -Biomarker studies -Public and global health studies Nature Medicine is also committed to facilitating communication between translational and clinical researchers. As such, we consider “hybrid” studies with preclinical and translational findings reported alongside data from clinical studies.

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