Evidence map›Paper›PMID 41402253›Full record

ArticleNature communications2025

Administrative-driven hierarchical management of atrial fibrillation on cardiovascular events: a prospective matched cohort study.

Mu Chen, Mingzhe Zhao, Yuli Yang, Xin Cui, Chunfang Wang, Tian Xia, Wenqi Tian, Peng Liao, Yudong Fei, Peng-Cheng Yao and 8 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Nature communications, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Mu ChenDepartment of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.ORCID http://orcid.org/0000-0002-7291-0041
Mingzhe ZhaoDepartment of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Yuli YangDepartment of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Xin CuiShanghai Health Statistics Center, Shanghai, China.
Chunfang WangShanghai Municipal Center for Disease Control & Prevention, Shanghai, China.
Tian XiaShanghai Municipal Center for Disease Control & Prevention, Shanghai, China.
Wenqi TianShanghai Health Statistics Center, Shanghai, China.
Peng LiaoSchool of Public Health, Fudan University, Shanghai, China.
Yudong FeiDepartment of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Peng-Cheng YaoDepartment of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Xiaoxiao ZhuShanghai Siwei Medical Co. Ltd., Shanghai, China.
Yongbo WuShanghai Siwei Medical Co. Ltd., Shanghai, China.
Mei YangDepartment of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Jian SunDepartment of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Li LuoSchool of Public Health, Fudan University, Shanghai, China.
Hong WuShanghai Municipal Health Commission, Shanghai, China.
Qunshan WangDepartment of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. wangqunshan@xinhuamed.com.cn.
Yi-Gang LiDepartment of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. liyigang@xinhuamed.com.cn.ORCID http://orcid.org/0000-0003-3007-7212

Funding

National Natural Science Foundation of China (National Science Foundation of China) 82070515National Natural Science Foundation of China (National Science Foundation of China) 82130009Science and Technology Commission of Shanghai Municipality (Shanghai Municipal Science and Technology Commission) 22Y11909900Shanghai Hospital Development Center (SHDC) SHDC2020CR2026BShanghai Municipal Health Bureau (Shanghai Municipal Public Health Bureau) 20224Y0078
6 · The paper itself

Abstract

The administrative-driven hierarchical management (ADHM) refers to the management model that general practitioners act as "voluntary gatekeepers" under local government policy incentives in the non-mandatory hierarchical medical system. However, the impact of ADHM of atrial fibrillation (AF) on cardiovascular events remains unclear. We enrolled 1455 patients with AF in the ADHM cohort and 7275 in the matched usual care (UC) cohort in Shanghai, China. During the 30 months follow-up, the rate of the primary outcome (the composite of ischemic stroke, systemic embolism, myocardial infarction, major bleeding, acute heart failure and cardiovascular death) was significantly lower in the ADHM cohort than the UC cohort (hazard ratio: 0.624; 95% confidence interval=0.554-0.703; p < 0.0001). Comparisons of the secondary endpoints, including all-cause death, cardiovascular death, ischemic stroke, and acute heart failure, also favored the ADHM cohort, while non-cardiovascular death, systemic embolism, myocardial infarction, and major bleeding were similar between cohorts. The medical costs per patient per survival day were lower in the ADHM cohort. In sum, the ADHM model is effective in reducing cardiovascular events in patients with AF. Trial number: ChiCTR2000036931.

Indexed as

Atrial FibrillationCardiovascular DiseasesAgedChinaFemaleHeart FailureHemorrhageHumansIschemic StrokeMaleMiddle AgedMyocardial InfarctionProspective Studies

Identifiers

PMID41402253
PMCPMC12738700

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.