Cognitive function and telemedicine-based, village doctor-led care for atrial fibrillation

Cognitive impairment is common among older patients with atrial fibrillation (AF). We aimed to evaluate whether baseline cognitive function modifies the effectiveness of a telemedicine-based, village doctor-led integrated care in older patients with AF.

This was a post hoc subgroup analysis of the MIRACLE-AF cluster-randomized trial conducted across 30 village clinics in China from December 2020 to May 2024. Rural participants aged ≥65 years with AF received telemedicine-based, village doctor-led integrated AF care or usual care. Participants were categorized by baseline Mini-Mental State Examination (MMSE) score into severe cognitive impairment (MMSE < 18), mild-to-moderate cognitive impairment (MMSE 18-23), and preserved cognition (MMSE ≥ 24). The primary outcome was a composite of cardiovascular death, all strokes, hospitalization for worsening heart failure or acute coronary syndrome, and emergency visits for AF.

Among 1039 participants enrolled in the MIRACLE-AF trial [mean (SD) age, 75.8 (5.7) years; 460 women (44.3%)], 1028 (98.9%) had baseline MMSE assessed (388 with MMSE < 18, 305 with MMSE 18-23, and 335 with MMSE ≥ 24). Compared with control, the intervention reduced the risk of the primary outcome among patients with MMSE 18-23 [adjusted hazard ratio (HR), 0.56; 95% CI, 0.34-0.92], MMSE ≥ 24 (adjusted HR, 0.55; 95% CI, 0.32-0.93), and MMSE < 18 (adjusted HR, 0.86; 95% CI, 0.54-1.35). P for interaction was 0.336.

A telemedicine-based, village doctor-led integrated care model was associated with favourable outcomes across baseline cognitive strata, warranting further evaluation among cognitively vulnerable adults with AF in rural settings.

ClinicalTrials.gov (identifier NCT04622514).