Telemedicine-based integrated management of atrial fibrillation in village clinics: a cluster randomized trial.

Summary

In a cluster randomized trial across 30 village clinics (n=1,039 older adults with AF), a telemedicine-based, village doctor–led integrated care model significantly increased adherence to AF care and reduced composite cardiovascular events versus usual care (HR 0.64, 95% CI 0.50–0.82). Benefits persisted over a median 34 months.

Key Findings

• At 12 months, integrated AF care adherence was 33.1% with telemedicine vs 8.7% with usual care (between-group difference 24.4%, 95% CI 18.3–30.5; P<0.001).
• Over 34.0 months, the rate of composite cardiovascular events was lower with telemedicine (6.2%/year) than usual care (9.6%/year); HR 0.64 (95% CI 0.50–0.82; P<0.001).
• Sustained improvement in adherence at ~34 months: 41.8% vs 10.3% meeting integrated care criteria (P<0.001).

Clinical Implications

Health systems can deploy telemedicine-supported, community clinician–led AF integrated care pathways to improve adherence and reduce cardiovascular events, especially in rural or underserved areas.

Limitations

• Single-country setting may limit generalizability to other health systems
• Potential contamination or variability in implementation across clusters

Future Directions

Evaluate cost-effectiveness, scalability across diverse health systems, and adaptation for other chronic cardiovascular conditions.