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Regular Bleeding Risk Assessment Associated with Reduction in Bleeding Outcomes: The mAFA-II Randomized Trial
Yutao Guo1, Deirdre A Lane2, Yundai Chen1
1Medical School of Chinese PLA, Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
The American Journal of Medicine
|April 15, 2020
Summary
Dynamic monitoring of bleeding risk with the HAS-BLED score and the mAFA-II app significantly reduced bleeding events and increased oral anticoagulant use in atrial fibrillation patients.
Area of Science:
- Cardiology
- Digital Health
- Pharmacology
Background:
- Atrial fibrillation management requires balancing stroke prevention with bleeding risk.
- Mobile health applications like mAFA-II have shown promise in managing atrial fibrillation.
- Assessing bleeding risk dynamically is crucial for optimizing oral anticoagulant therapy.
Purpose of the Study:
- To evaluate the impact of regular Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile international normalized ratio, Elderly, Drugs or alcohol (HAS-BLED) score reassessment on bleeding outcomes.
- To determine if dynamic bleeding risk monitoring improves oral anticoagulant (OAC) uptake in atrial fibrillation patients.
- To assess the effectiveness of the mAFA-II mobile health application in conjunction with HAS-BLED score monitoring.
Main Methods:
- Prospective monitoring of HAS-BLED scores at 30-day intervals using the mAFA-II application.
- Analysis of clinical events and changes in OAC therapy in relation to dynamic bleeding risk monitoring.
- Comparison of outcomes between patients with dynamic monitoring and those receiving usual care.
Main Results:
- The proportion of atrial fibrillation patients with a HAS-BLED score ≥3 decreased from 11.8% to 8.5% over 12 months.
- Incident bleeding events significantly decreased from 1.2% to 0.2% in patients with four bleeding risk assessments.
- Bleeding events were significantly lower (2.1% vs 4.3%) in patients with dynamic monitoring compared to usual care, and OAC use increased from 63.4% to 70.2%.
Conclusions:
- Dynamic bleeding risk monitoring using the HAS-BLED score, integrated with the mAFA-II app, effectively reduces bleeding events.
- This approach helps address modifiable bleeding risks and enhances the appropriate use of oral anticoagulants.
- Mobile health strategies combined with regular risk assessment improve patient outcomes in atrial fibrillation.
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