Village doctors in rural China trained to manage the care of older adults with atrial fibrillation (AFib) and supported by AFib experts in tertiary hospitals through telemedicine lowered the risk of AFib-related adverse cardiovascular events by 36% over three years, based on findings from the MIRACLE-AF trial presented at ESC Congress 2024 in London.

The study randomly assigned 1,039 adults with AFib from 30 villages in rural China to receive either village doctor-led telemedicine integrated care or enhanced usual care with intensified AFib education given to all patients and their families. Before randomization, village doctors received intensified training around integrated AFib care management.

Overall results found that rates of the composite primary outcome of cardiovascular death, stroke, hospitalization due to worsening of heart failure or acute coronary syndrome, and emergency visits due to AFib were 36% lower in the intervention group compared with the control group. Specifically, the risk of cardiovascular death was 50% lower in the intervention group (24 events vs. 47 events), while the risks of stroke and hospitalization due to worsening of heart failure or acute coronary syndromes were 36% and 31% lower, respectively. Researchers did note that clinically relevant, nonmajor bleeding was higher in the intervention group compared with the control group (9 events vs. 3 events), reflecting treatment with anticoagulant therapy.

"The magnitude of the reduction in serious cardiovascular events in patients in the intervention group is impressive," said Minglong Chenat, MD. "Our results indicate that the telemedicine-based, village doctor-led, AFib specialist-supported intervention was effective and is a feasible and sustainable implementation strategy that could be scaled-up to improve the management of AFib in the older population across rural China and in other low-and-middle income countries with limited health care access."