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Administrative-driven hierarchical management of atrial fibrillation on cardiovascular events: a prospective matched

Mu Chen1, Mingzhe Zhao1, Yuli Yang1

  • 1Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Nature Communications
|December 16, 2025
PubMed

Insights

The administrative-driven hierarchical management (ADHM) model significantly reduced cardiovascular events in atrial fibrillation (AF) patients. This approach also lowered medical costs, demonstrating its effectiveness in managing AF care.

Area of Science:

  • Cardiology
  • Public Health
  • Health Management

Background:

  • The administrative-driven hierarchical management (ADHM) model involves general practitioners acting as gatekeepers, incentivized by local government policies within a hierarchical medical system.
  • The impact of ADHM on cardiovascular events, specifically in atrial fibrillation (AF) patients, has not been clearly established.

Purpose of the Study:

  • To evaluate the effectiveness of the ADHM model in reducing cardiovascular events and healthcare costs among patients with atrial fibrillation (AF).

Main Methods:

  • A cohort study was conducted in Shanghai, China, enrolling 1455 AF patients in the ADHM cohort and 7275 matched patients in the usual care (UC) cohort.
  • Follow-up was conducted over 30 months, monitoring a primary composite outcome of ischemic stroke, systemic embolism, myocardial infarction, major bleeding, acute heart failure, and cardiovascular death, along with secondary endpoints and medical costs.

Main Results:

  • The ADHM cohort exhibited a significantly lower rate of the primary composite outcome compared to the UC cohort (HR: 0.624; 95% CI: 0.554-0.703; p < 0.0001).
  • Secondary endpoints, including all-cause death, cardiovascular death, ischemic stroke, and acute heart failure, were also reduced in the ADHM cohort. Rates of non-cardiovascular death, systemic embolism, myocardial infarction, and major bleeding were similar between groups.
  • The ADHM model resulted in lower medical costs per patient per survival day.

Conclusions:

  • The administrative-driven hierarchical management (ADHM) model is effective in decreasing cardiovascular events for patients diagnosed with atrial fibrillation (AF).
  • The ADHM approach also demonstrates cost-effectiveness, suggesting its value in managing AF care within healthcare systems.

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