Atrial Fibrillation Integrated Approach in Frail, Multimorbid and Polymedicated Older People

Lip, G. Y. H.; Proietti, M.; Ainsworth, J.

doi:10.1016/j.lanepe.2026.101832

AFFIRMO

Atrial Fibrillation Integrated Approach in Frail, Multimorbid and Polymedicated Older People

Patient / Population Intervention / Exposure Comparison Outcome

In 1,260 older patients with atrial fibrillation and multimorbidity, app-supported integrated care on the ABC pathway did not reduce unplanned hospitalisation at 12 months compared with usual care.

N

1,260patients

Design

European multicentre, open-label, cluster-randomised trial; centres randomised 1:1 to the iABC integrated-care pathway or usual care; 66 sites in 6 countries (Bulgaria, Denmark, Italy, Romania, Serbia, Spain); 12-month follow-up

Endpoint

unplanned all-cause hospitalisation at 12 months

Relevance

3Supporting — context rather than must-know.

ResultUnplanned all-cause hospitalisation at one year 17.1% vs 18.2% (OR 0.95, 95% CI 0.61-1.49; P = 0.84). Guideline adherence was very high in both arms at baseline.

Lip GYH, Proietti M, Ainsworth J, et al. Lancet Reg Health Eur. 2026;101832. 10.1016/j.lanepe.2026.101832

Discussion & critique

An app plus a comprehensive geriatric assessment, built to raise adherence to the ABC pathway in older patients with atrial fibrillation and comorbidity — and adherence was already very high in both arms, so there was nothing left to raise. The trial therefore tests a fix for a problem its own participants did not have, which the investigators say plainly; app use was low as well. Read against TIME-HF in the same congress, where baseline four-pillar therapy was 22%: the same kind of intervention works where the gap is, and does nothing where it is not.