Accès ouvert déclaré
2026
article
Integrated care management and comprehensive geriatric assessment using a mHealth-based approach in older multimorbid patients with atrial fibrillation: the AFFIRMO cluster-randomised trial
Gregory Y.H. Lip, Marco Proietti, John Ainsworth, Gheorghe-Andrei Dan, Lars Frost, Guendalina Graffigna, Deirdre A. Lane, Donata Lucci, Gianna Fabbri, Francisco Marin, Martín O’Flaherty, Mirko Petrović, Tatjana Potpara, Riccardo Proietti, Alam Sanaullah, Mariya Tokmakova, Davide Liborio Vetrano, Søren Paaske Johnsen, Aldo P. Maggioni, C Gamble, Mariya Tokmakova, Marco Proietti, Tatjana Potpara, Francisco Marín Ortuño, Elena Arbelo, Giuseppe Di Pasquale, Laurent Fauchier, Diana Gorog, Jennifer Meessen, Elina Trendafilova, Axel Brandes, Roberto Cemin, Stefan Bogdan, D Djikic, David Vivas, Francesco Orso, Andrea Lorimer, Martina Ceseri, Marco Gorini, Francesca Bianchini, Ester Baldini, B Bartolomei Mecatti, Lucio Gonzini, Ангел Джамбов, Emanuela Vasileva, Kostadin Kostadinov, Пенка Атанасова, Gitte Berg Jensen, Anita Egholm, Peter Brønnum Nielsen, Adrian Catalina Buzea, Anca Rodica Dan, Raluca Popescu, Dejan Kojic, Miroslav Mihajlovic, Nebojsa Mujovic, Cecilia López García, José Miguel Rivera Caravaca, Maria Asuncion Esteve Pastor, Miguel Ángel Sánchez Pérez, Vanessa Roldán Schilling, Antony Gogov, Kostadin Kichukov, Krastyu Penchev, Vladimir Ivanov, Rafiela Chitak, Iskren Garvanski, V. Traykov, Elena Kostova-Dimitrova, Susanne Hekla Ringholm Hansen, Morten Lamberts, Annette Jonstrup Nielsen, Albert Marni Joensen, Birthe Falkenberg Bjerremand, Karen Kaae Dodt, Paolo Calabrò, Felice Gragnano, Alessandro Paoletti Perini, Serena Fatucchi, Maria Luisa Biorci, Sergio Agosti, Luigi Addonisio, Paolo Orselli, Deborah Cosmi, Niccolò Sisti, Valeria Benaglia, Elena Piazzi, Serena Vaghi, Alberto M. Marra, Antonio Cittadini, Daniela Aschieri, Maria Giulia Bolognesi, Stefania Basili, Giulio Francesco Romiti, Giacomo Pucci, A Lelli, Marzia De Biasio, Elisabetta Daleffe, Crina Sinescu, Cosmina-Elena Jercalau, S M Balanescu, Andra Ioana Rădoi, Alexandru Scafa‐Udriște, Diana Irene Stanciulescu, Ilinca Mihaela Savulescu-Fiedler, R. Siliste, Silviu Stanciu, Maria Magdalena Gurzun, Iustin-Robert Dobre, Cristian Băicuş, Larisa Pinte, Andreea Cristina Ivănescu, Ana Maria Balahura, Mihai Grigore, Milan Marinković, Jelena Simic, Tanja Jozić, Jelena Kravic, Anja Radunović, Marija Zdravkovic, Dušan Radovanovic, Radosav Vidakovic, Stefan Mijatović, Ivana Djokic-Nikolic, Zorica Smiljanić, Tomislav Kostic, Miroslav Nikolic, Amaya García Fernández, María Ajo Ferrer, I. Ortega, Pablo Gil Pérez, Jorge Rodríguez Capitán, Marina Benítez Pérez, Antonio García Honrubia, Celia María Andreu Concha, Alejandro Isidoro Pérez Cabeza, Beatriz Vaquera Amaya, Tomás Vicente Vera, Francisco Cambronero Sánchez, José Moreno‐Arribas, Jose Luis Ferreiro Gutierrez, Ylènia Avivar Sáez, Leydimar Adel Anmad, Silvia Gabriela Sosa Olguin, SØren Påske Johnsen, Riccardo Poietti, Gregory Lip, Deirdre Lane, Martin O'Flaherty, Iain Buchan, Christodoulos Kypridemos, Brendan Collins, Donato Leo, Mirko Petrovic, D. M. De Smedt, Stefanie De Buyser, Cheïma Amrouch, Amaia Calderón-Larrañaga, Lu Dai, Stefania Maggi, Marianna Noale, Elisabeta Bădilă, Nicola Ferri, Alessandra Buja, Giuseppe Sergi, Vincenzo Rebba, Caterina Trevisan, Laura Vivani, Silvia Ananstasia, Alessandro Ferri, Gehad Shehata, Nadia Rosso, Marco Cicerone, Jacek Marczyk, Trudie Lobban, Georg Ruppe, Graziano Onder, Federica Censi, Robero Da Cas, Cecilia Damiano, Caterina Bosio, Lorenzo Palamenghi, Serena Barello, Dipak Kalra, Nathan Lea, Charlotte Stockton-Powdrell, José Miguel Rivera-Caravaca
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Résumé fourni par la source
Background The AFFIRMO trial aimed to evaluate the efficacy of a mobile-health (mHealth) structured intervention adapting the Atrial Fibrillation Better Care (ABC) pathway, combining the comprehensive geriatric assessment (CGA), to enhance guideline-directed, holistic AF management and reduce the risk of clinical outcomes in older patients with atrial fibrillation (AF) and multimorbidity. Methods In a multicentre, open-label, cluster-randomised study conducted in six European countries, clusters were allocated to usual care or intervention (iABC system) (ClinicalTrials.gov NCT06775028, https://clinicaltrials.gov/study/NCT06775028). In usual care clusters, patients were managed according to clinical guidelines. Findings We enrolled 1260 patients (mean [SD] age 74 [6] years; 44.4% (560/1260) female; median CHA 2 DS 2 -VASc 4 [IQR 3–5]), with 634 (50.3%) assigned to intervention and 626 (49.7%) to usual care. Overall, 41.0% (517/1260) had >2 comorbidities, with a high prevalence of anticoagulation (1226, 97.3%) and guideline-recommended therapies. CGA in the intervention arm documented a highly preserved function. The primary endpoint of all-cause unplanned hospitalisation occurred in 108 (17.1%) and 114 (18.2%) patients in the intervention and usual care groups [adjusted OR 0.95, 95% CI 0.61–1.49; p=0.84]. Use of the AFFIRMO Mobile App was suboptimal, with 68.5% (433/632) of patients using it for only one-third of the observation time. Interpretation In a setting of high baseline guideline adherence and low event rates, the iABC system did not reduce unplanned hospitalisations compared with usual care. These findings suggest no incremental benefit of mHealth integrated care interventions when applied to optimally managed populations, particularly in the context of suboptimal intervention uptake. Funding European Union's Horizon 2020 Research and Innovation Program (grant agreement 899871).
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Contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Integrated care management and comprehensive geriatric assessment using a mHealth-based approach in older multimorbid patients with atrial fibrillation: the AFFIRMO cluster-randomised trial
- Date Crossref
- 01/08/2026
- Éditeur
- Elsevier BV
- Type
- journal-article
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Sujets associés
Atrial Fibrillation Management and OutcomesChronic Disease Management StrategiesHeart Failure Treatment and Management