Telemedicine led by village doctors reduces cardiovascular events in rural China
Telemedicine support for village doctors may be key to improving healthcare access for rural China’s elderly, particularly those at risk of life-threatening complications from untreated atrial fibrillation (AF), according to research presented at the ESC Congress 2024 in London, UK.
AF, a common heart rhythm disorder, is a leading cause of ischemic stroke, affecting an estimated 1.6% of adults in China, or about 18 million people. Rural healthcare in China, often led by village doctors, struggles to provide optimal AF management. This study included 1,039 adults aged 65 and older from 30 villages in Jiangdu County, Jiangsu Province. Prior to randomization, village doctors were trained in AF management following the Atrial Fibrillation Better Care (ABC) pathway.
Between December 2020 and May 2022, village clinics were randomly assigned to either telemedicine-led care by village doctors (intervention group) or enhanced usual care with intensified AF education for patients and families (control group). Village doctors in the intervention group received telemedicine support and supervision from AF specialists at tertiary hospitals.
Of the participants, 524 adults from 15 villages (average age 76, 45% female) received the intervention, while 515 adults (average age 76, 43% female) in the control group received enhanced care due to the ABC training provided to all village doctors.
After one year, 33% of the intervention group and 8.8% of the control group met all three ABC pathway criteria, a 24% difference. By three years, 42% of the intervention group met the criteria, compared to 10% in the control group, a 31% difference. Cardiovascular events were 36% lower in the intervention group, with fewer cardiovascular deaths (50% reduction), strokes (36% reduction), and hospitalizations for heart failure or acute coronary syndrome (31% reduction). However, non-major bleeding was higher in the intervention group due to anticoagulant therapy (9 vs. 3 events).
Professor Chen noted, “The telemedicine-based, village doctor-led intervention was effective and could be scaled up to improve AF management in rural China and other low- and middle-income countries with limited healthcare access.”