Structured rehabilitation for patients with atrial fibrillation based on an integrated care approach

Abstract Purpose The study aimed to investigate whether mobile health technology supported structured rehabilitation management (mAFA III) for patients with atrial fibrillation (AF) adapted to personalized risk and different treatments pattern could improve guidelines compliance . Methods Based on the previously developed and validated application for the management of patients with atrial fibrillation (mAFA), anticoagulants and structured home-based rehabilitation management were updated for AF patients on medication, or post-AF ablation and/or post-Left atrial appendage occlusion (LAAO). Anticoagulants adapted home rehabilitation program mainly provides optimal anticoagulant management; Home-based rehabilitation program for AF patients post AF ablation and/or LAAO provides rhythm/heart rate management including prediction and management of AF recurrence and post-procedure antithrombotic management. This study was a prospective cohort study. AF patients were recruited through the mAFA between May 31, 2021 and May 31, 2023, and followed up for at least 12 months. The primary endpoint event was compliance with integrated AF management ABC pathway, and the secondary endpoint event was cardiovascular dverse events. Results A total of 1,272 patients completing 12-month follow up were included in this study , of which 1,141 patients (mean age 54±14; Men (84.2%) received a structured rehabilitation regimen only on medication, and 151 patients (mean age 52±16; Men (83.5%) underwent a structured rehabilitation program post AF ablation and/or LAAO. Compliance of patients on medication only at baseline and 12-month follow-up: A pathway (Anticoagulation and Avoid Stroke)-compliance with anticoagulation: 55.9% and 62.5% (p 0.05). B pathway (Better Symptom Management)-compliance in patients with AF combined with heart failure (HF) or coronary heart disease (CHD) receiving guide-recommended heart rate/rhythm medications was 8.6% and 19.4% (p 0.05). C pathway (cardiovascular and Comorbidity Optimization)-adherence to guidance-recommended medication in patients with AF combined with HF, hypertension, and CHD was 50.1% and 58.3%, 43.2% and 56.3%, 61.3% and 75.8% respectively (all p 0.05). Patients' compliance post AF ablation or/and LAAO at baseline and 12-month follow-up: A: 62.9% and 48.3%, (p 0.05). B: 5.3% and 13.9% (p 0.05). C: 54.8% and 65.2%, 52.4% and 61.9%, 66.7% and 81.0% respectivelu (all p 0.05). After adjusting for confounders, structured home rehabilitation management significantly reduced the risk of bleeding (OR=0.05, 95%CI 0.03-0.08,p0.001) and thrombosis (OR=0.06, 95%CI 0.03-0.08,P0.001) in both groups. Conclusion The personalized "digital home rehabilitation management" program supported by mobile technology, which provides patient management support according to their risk characteristics and different treatment modes after discharge, could significantly improve the compliance of AF patients with the ABC pathway of guideline.