Mobile health technology integrated care in atrial fibrillation patients according to atrial fibrillation subtype: a subgroup analysis of the mAFA-II randomised trial

Abstract Background Atrial fibrillation (AF) is clinically categorised into different types (e.g. paroxysmal, persistent and permanent AF) according to the duration of the arrhythmia and whether it is accepted by physician and patient. These types of AF usually recognise different arrhythmic substrates, any may show different response to rate and rhythm control treatments. The Mobile Health Technology for Improved Screening and Optimized Integrated Care in AF (mAFA-II) prospective cluster randomised trial proved the efficacy of a mobile health (mHealth) implemented ‘Atrial fibrillation Better Care’ (ABC) pathway (mAFA intervention) for the integrated care management of patients with AF. Whether the effect of mAFA intervention could differ between different types of AF is still unknown. Purpose To assess the efficacy of mAFA intervention according to the type of AF. Methods mAFA-II was a cluster randomised trial which recruited 3,324 adults AF patients between June 2018 and August 2019 in 40 centres in China. Clusters were randomised in a 1:1 ratio to mAFA intervention or usual care. In this analysis, we included patients with either paroxysmal, persistent or long-standing/permanent AF; we then assessed the interaction between these three types of AF and the effect of mAFA intervention on the risk of major outcomes using multivariable Cox regression analysis. Results were expressed as adjusted Hazard Ratio (aHR) and 95% Confidence Intervals (95%CI). The primary outcome was the composite of ischemic stroke/thromboembolism, all-cause death, and rehospitalizations. Results 2,489 AF patients were included in this analysis (mean age: 69.6±13.2, females 37.8%). Of these, 1,333 had paroxysmal AF (673 allocated to mAFA intervention), 828 had persistent AF (380 allocated to mAFA intervention), and 328 had long-standing/permanent AF (104 allocated to mAFA intervention). Patients with long-standing/permanent AF were older and more likely burdened by several comorbidities. On multivariable Cox regression analysis, the efficacy of the mAFA intervention on the risk of the primary composite outcome was similar in the three groups, without statistically significant interaction (p for interaction=0.337), with the highest effect seen among patients with persistent AF (aHR: 0.27, 95%CI: 0.11-0.66). Conclusions A mHealth-technology implemented ABC pathway showed a similar effect on the reduction of the primary composite outcome among patients with different subtype of AF. Thes