Shimeng Zhang,1,* Ming Chu,1,2,* Dechuan Lu,3,* Youmei Shen,1 Xingxing Sun,1 Yaodongqin Xia,1 Shu Yang,1 Jinlong Gong,3 Li Hong,3 Mingfang Li,1 Gregory YH Lip,4,5 Minglong Chen1,2 

1Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, People’s Republic of China; 2Department of Cardiology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, People’s Republic of China; 3Department of Cardiology, Jiangdu People’s Hospital Affiliated to Yangzhou University, Yangzhou, People’s Republic of China; 4Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; 5Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

*These authors contributed equally to this work

Correspondence: Gregory YH Lip, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK, Tel +44-0151-794 9020, Email gregory.lip@liverpool.ac.uk Minglong Chen, Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People’s Republic of China, Tel +86-25-68303115, Fax +86-25-6813-6479, Email chenminglong@njmu.edu.cn

Background: Exploring an integrated care management model to effectively deliver the standardized management to atrial fibrillation (AF) elderlies in rural China.
Purpose: The objective of this study was to assess whether intensified multifaceted education (IME) targeting AF elderlies, their family members, and the village doctors (VD) can increase compliance for rural AF elderlies with integrated care based on the AF Better Care (ABC) pathway. Additionally, the capacity of VD to deliver integrated AF care was investigated.
Patients and Methods: This is a self-controlled cohort study before and after IME, including AF patients aged ≥ 65 years identified in phase-I of The Jiangsu Province Rural Community AF Project. The IME model was defined as 12 months of continuous knowledge education on integrated care management of AF based on the ABC pathway, delivered to AF patients, their family members and the village doctors. AF knowledge evaluation from VD and compliance with the ABC pathway before and after the IME model were evaluated.
Results: A total of 810 AF patients (mean age 76.1 ± 5.9 years; 51.4% women) were enrolled. After 12 months, the AF knowledge score of VD was significantly improved [(65.0 ± 13.0) scores vs (53.1 ± 9.8) scores, P < 0.001]. Although the compliance of AF patients with the ABC pathway was improved statistically (4.3% vs 1.7%, P = 0.003), the absolute increase was small.
Conclusion: Although VD have the potential to serve as AF integrated care management providers, the impact of the IME model used to improve the standard AF care in rural elderly AF population was small.

Keywords: education, atrial fibrillation, village doctors, rural, elderly