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Novel Model of Integrated Care of Older Patients With Atrial Fibrillation and Heart Failure in Rural China (MIRACLE-AFHF)
Sponsor: Jiangsu Taizhou People's Hospital
Summary
This cluster randomization study aims to compare village-doctor led integrated care versus usual care to improve heart failure risk management, guideline-directed medical therapy, self-management adherence, and clinical outcomes for older patients with atrial fibrillation and heart failure in rural China.
Key Details
Gender
All
Age Range
65 Years - 80 Years
Study Type
INTERVENTIONAL
Enrollment
942
Start Date
2026-08-01
Completion Date
2029-12-30
Last Updated
2026-07-28
Healthy Volunteers
No
Conditions
Interventions
Village-Doctor Led Integrated Care
1. Village doctors will conduct monthly follow-up, including clinical assessment, vital-sign monitoring, medication review, risk screening, health education, and referral when needed. 2. For patients with clinical deterioration or treatment difficulties, village doctors may use a remote care platform to obtain specialist consultation and individualized recommendations. 3. Village doctors will receive standardized training based on the AF ABC pathway and heart failure GDMT principles. 4. Patients will receive structured education on medication adherence, symptom monitoring, lifestyle modification, and recognition of warning signs.
Usual Care
Usual care includes routine follow-up, general health education, medication registration, and standard referral procedures provided by local primary care providers. Participants will not receive the structured village-doctor led integrated care program.
Locations (3)
Village Clinics in Dongtai City, Jiangsu Province
Yancheng, Dongtai, China
Village Clinics in Jiangdu District, Jiangsu Province
Yangzhou, Jiangdu, China
Village Clinics in Suining County, Jiangsu Province
Xuzhou, Suining, China