New research co-led by the University of Liverpool offers valuable insights to improve healthcare for elderly residents in rural Chinese villages who are at risk of life-threatening heart conditions.
A clinical trial conducted by Liverpool Centre for Cardiovascular Science (LCCS) researchers, working in close collaboration with healthcare experts in Nanjing, China, demonstrates that a telemedicine-based, village doctor-led care model significantly enhanced the management of atrial fibrillation (AF). AF is a common heart condition linked to a higher risk of stroke, dementia, heart failure, and death - with 1 in 3 adults at risk of developing it.
In China's rural areas, where around 500 million people live, many elderly residents (age 65+) struggle with limited healthcare access. Village doctors play a crucial role as primary healthcare providers but often lack specialised training in managing chronic diseases. Telemedicine, which uses technology to provide medical care remotely, offers a promising solution.
The MIRACLE-AF trial was a randomised clinical study conducted in Jiangdu County, Jiangsu Province in the east of China. A total of 30 village clinics were randomly assigned to either the intervention group (telemedicine-based integrated care) or the control group (usual care). The study enrolled 1,039 rural residents aged 65 years or older diagnosed with AF.
Care given to the intervention group was based on the AF Better Care (ABC) pathway, which is a holistic management approach to AF developed and validated by LCCS researchers and recommended in international guidelines. The ABC pathway focuses on three core approaches: 'A', avoid stroke by appropriately using blood clot prevention therapy; 'B', better patient centred symptom management; and 'C', cardiovascular and comorbidity risk factor management.
The telemedicine-based model utilised in the MIRACLE-AF trial provided village doctors with real-time expert consultation and support, continuous education and training, quality control monitoring to ensure adherence to evidence-based guidelines, and a centralised data repository for patient tracking and management. By integrating these digital health tools, village doctors were empowered to provide higher-quality AF care, resulting in better patient outcomes.
Key findings from the trial include the rate of major cardiovascular events, including cardiovascular death, stroke, or heart failure was lower in the telemedicine-based group than in the usual care group. Importantly, at 12 months, adherence to integrated AF care, based on the ABC pathway, was significantly higher in the telemedicine-based group compared to the usual care group.
Professor Gregory Lip, Price-Evans Chair of Cardiovascular Medicine, NIHR Senior Investigator and Director of Liverpool Centre for Cardiovascular Science, University of Liverpool said: "This study demonstrates the effectiveness of a telemedicine-based, village doctor-led approach in bridging the gap in AF management in rural China. By leveraging technology and local healthcare providers, we can ensure that even the most underserved populations receive high-quality, evidence-based care. Significantly, we can even also promote the ABC pathway more widely as an effective approach to AF management and care, sometimes called an 'Easy as ABC' approach.
"The success of the MIRACLE-AF trial paves the way for the broader implementation of telemedicine solutions to address other chronic diseases in rural populations. We are hopeful that similar models can be adapted to different healthcare settings, improving health outcomes for millions of rural residents worldwide."
The ABC pathway is also being tested in a clinical trial in Europe, as part of the Horizon Europe funded AFFIRMO project, co-led by LCCS: www.affirmo.eu.
The paper, 'Telemedicine-based integrated management of atrial fibrillation in village clinics: a cluster randomized trial' was published in Nature Medicine (DOI: 10.1038/s41591-025-03511-2).
