MIRACLE-AF: Elegant solution to improve AF care in rural China

Through telemedicine, village doctors in rural China were able to professionalise the management of atrial fibrillation (AF) among elderly patients, improving clinical outcomes in this population with limited access to high-quality healthcare. According to the authors, the used model could serve as a blueprint for similar settings across the globe.

“Elderly patients with AF in rural China are difficult to reach due to their low educational level, limited access to information technology, long travel time to hospitals, and travel difficulties,” explained Prof. Minglong Chen (First Affiliated Hospital of Nanjing Medical University, China) [1]. “The only way we can reach them is to empower village doctors to provide good quality chronic disease care.”

Prof. Chen and colleagues designed a novel integrated AF care model that connects AF specialists and village doctors through telemedicine to deliver quality AF care. The cluster-randomised MIRACLE-AF trial (NCT04622514) tested the value of this care model with 1,039 participants from 30 villages. The participants were randomised to the telemedicine arm or to usual care. The first primary outcome was adherence to the ABC pathway at 12 months (i.e. Avoid stroke by appropriately using anticoagulant therapy, Better symptom management with patient-centred symptom-directed rhythm or rate control, and Cardiovascular and comorbidity risk factor management). The second primary outcome was a composite of cardiovascular events at 36 months.

At 12 months, adherence to the ABC pathway was significantly increased in the intervention arm compared with the control arm (33.1% vs 8.7%; P<0.001). This effect was driven by the uptake of anticoagulation therapy in the telemedicine arm (85.2% vs 20.8%; P<0.001). Furthermore, participants in the intervention arm had fewer cardiovascular events at 3 years of follow-up than those in the control arm (6.2% vs 9.6% per year; HR 0.64; 95% CI 0.50–0.82; P<0.01).

Annual cardiovascular death (1.7% vs 3.4%; HR 0.50; 95% CI 0.32–0.80; P=0.004), annual stroke rate (1.5% vs 2.4%; HR 0.64; 95% CI 0.41–1.00; P=0.049), and annual hospitalisation due to heart failure or acute coronary syndrome (3.2% vs 4.7%; HR 0.69; 95% CI 0.49–0.95; P=0.025) were all significantly lower in the telemedicine arm than in the control arm.

“The MIRACLE-AF model appears to be a well-rounded solution for improving AF care delivery that could be generalised to the older population across rural China and other low- and middle-income countries with limited healthcare access,” concluded Prof. Chen.

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   1. Chen M, et al. A novel model of integrated care of older patients with atrial fibrillation on cardiovascular outcomes in rural China. HOTLINE 9, ESC Congress 2024, 30 Aug–02 Sept, London, UK.

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Posted on 7 November 20247 November 2024