Arrhythmias & electrophysiology

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

Nat MedPublished Cluster randomised controlled trial

Authors' conclusion

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.

Study context

Population
Village residents aged ≥65 years with atrial fibrillation (AF) in rural China (30 village clinics)
Participants
1,039 residents30 village clinics
Comparison
Telemedicine-based, village doctor-led integrated AF care vs usual care
Primary endpoint
Stage 1: adherence to integrated AF care; stage 2: composite of CV death, all strokes, HF or ACS hospitalization, and AF emergency visits
Follow-up
12 months (stage 1); 36 months (stage 2)
Methodological details1:1 randomisation, two stages
  • 1:1 randomisation
  • Two stages

Primary result

As reported in the abstract

Telemedicine-based, village doctor-led care

Met all criteria for integrated AF care at 12 months
33.1%
Composite CV event rate
6.2% per year

Usual care

Met all criteria for integrated AF care at 12 months
8.7%
Composite CV event rate
9.6% per year

Met all criteria for integrated AF care at 12 months

Telemedicine-based, village doctor-led care33.1%
Usual care8.7%

Composite CV event rate

Telemedicine-based, village doctor-led care6.2% per year
Usual care9.6% per year
Telemedicine-based, village doctor-led care vs Usual careBetween-group difference (95% CI)P value
Adherence to integrated AF care at 12 months
24.4%(18.3–30.5%)
P < 0.001
Telemedicine-based, village doctor-led care vs Usual careHazard ratio (95% CI)P value
Composite CV event outcome
0.64(0.50–0.82)
P < 0.001

Further findings

Met all criteria for integrated AF care · Over 34.0 months

P < 0.001

Original publication

Telemedicine-based integrated management of atrial fibrillation in village clinics: a cluster randomized trial. Nat Med. Published 21 February 2025. doi:10.1038/s41591-025-03511-2

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