Article Impact Level: HIGH Data Quality: STRONG Summary of Nature Medicine, 1–10. https://doi.org/10.1038/s41591-025-03511-2 Dr. Ming Chu et al.
Points
- A telemedicine-based, village doctor-led integrated care model was tested in rural China to improve atrial fibrillation (AF) management among 1,039 residents aged ≥65 years across 30 village clinics.
- After 12 months, 33.1% of participants in the intervention group met all integrated AF care criteria, compared to only 8.7% in the usual care group (difference: 24.4%; 95% CI, 18.3–30.5%; P < 0.001).
- Over 34 months, the intervention group had a significantly lower rate of composite cardiovascular events (6.2% per year) compared to the usual care group (9.6% per year), with a hazard ratio of 0.64 (95% CI, 0.50–0.82; P < 0.001).
- The telemedicine-based approach led to fewer cardiovascular deaths, strokes, heart failure incidents, acute coronary syndrome hospitalizations, and AF emergency visits.
- The study demonstrates that a village doctor-led, telemedicine-integrated care model can improve AF management and health outcomes in resource-limited settings.
Summary
In rural China, where healthcare relies on nonspecialized village doctors, managing complex conditions like atrial fibrillation (AF) presents significant challenges. A telemedicine-based, village doctor-led integrated care model was developed and tested to address these issues in a cluster randomized clinical trial. The study included 30 village clinics, randomly assigned (1:1) to either the intervention or control group. A total of 1,039 residents aged ≥65 years with AF (44.3% women) were recruited. The trial evaluated adherence to integrated AF care at 12 months (Stage 1) and the incidence of composite cardiovascular events over 36 months (Stage 2).
The primary outcome in Stage 1 was adherence to integrated AF care. At 12 months, 33.1% of participants in the telemedicine-based intervention group met all criteria for integrated AF care, compared to only 8.7% in the usual care group (between-group difference: 24.4%, 95% CI, 18.3–30.5%, P < 0.001). In Stage 2, which assessed clinical outcomes over 34 months, the intervention group demonstrated a significantly lower rate of composite cardiovascular events (cardiovascular death, all strokes, heart failure, acute coronary syndrome hospitalization, and AF emergency visits). The rate of events was 6.2% per year in the intervention group compared to 9.6% per year in the usual care group (hazard ratio, 0.64; 95% CI, 0.50–0.82; P < 0.001).
These results demonstrate that the telemedicine-based, village doctor-led integrated care model significantly improves adherence to AF care and clinical outcomes in rural areas compared to traditional care. The intervention substantially reduced cardiovascular events, suggesting its potential as a viable model for AF management in resource-limited settings.
Link to the article: https://www.nature.com/articles/s41591-025-03511-2
References Chu, M., Zhang, S., Gong, J., Yang, S., Yang, G., Sun, X., Wu, D., Xia, Y., Jiao, J., Peng, X., Peng, Z., Hong, L., Wang, Z., Li, M., Lip, G. Y. H., & Chen, M. (2025). Telemedicine-based integrated management of atrial fibrillation in village clinics: A cluster randomized trial. Nature Medicine, 1–10. https://doi.org/10.1038/s41591-025-03511-2
