Trial reportEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2026
Cognitive function and telemedicine-based, village doctor-led care for atrial fibrillation.
Trial report in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04622514 (A New Model of Integrated Care of Older Patients With Atrial Fibrillation in Rural China), which is not on this map. Not yet cited in PubMed.
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The trial behind it
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A New Model of Integrated Care of Older Patients With Atrial Fibrillation in Rural China: a Cluster Randomization Trial (the MIRACLE-AF Trial)
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8 authors.
Funding
Abstract
aimsCognitive impairment is common among older patients with atrial fibrillation (AF). We aimed to evaluate whether baseline cognitive function modifies the effectiveness of a telemedicine-based, village doctor-led integrated care in older patients with AF.
methodsThis was a post hoc subgroup analysis of the MIRACLE-AF cluster-randomized trial conducted across 30 village clinics in China from December 2020 to May 2024. Rural participants aged ≥65 years with AF received telemedicine-based, village doctor-led integrated AF care or usual care. Participants were categorized by baseline Mini-Mental State Examination (MMSE) score into severe cognitive impairment (MMSE < 18), mild-to-moderate cognitive impairment (MMSE 18-23), and preserved cognition (MMSE ≥ 24). The primary outcome was a composite of cardiovascular death, all strokes, hospitalization for worsening heart failure or acute coronary syndrome, and emergency visits for AF.
resultsAmong 1039 participants enrolled in the MIRACLE-AF trial [mean (SD) age, 75.8 (5.7) years; 460 women (44.3%)], 1028 (98.9%) had baseline MMSE assessed (388 with MMSE < 18, 305 with MMSE 18-23, and 335 with MMSE ≥ 24). Compared with control, the intervention reduced the risk of the primary outcome among patients with MMSE 18-23 [adjusted hazard ratio (HR), 0.56; 95% CI, 0.34-0.92], MMSE ≥ 24 (adjusted HR, 0.55; 95% CI, 0.32-0.93), and MMSE < 18 (adjusted HR, 0.86; 95% CI, 0.54-1.35). P for interaction was 0.336.
conclusionA telemedicine-based, village doctor-led integrated care model was associated with favourable outcomes across baseline cognitive strata, warranting further evaluation among cognitively vulnerable adults with AF in rural settings. CLINICAL
trial registrationClinicalTrials.gov (identifier NCT04622514).
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