Abstract
Atrial fibrillation is one of the most common arrhythmias and is associated with an increased risk of stroke, heart failure, and mortality. Effective management of these patients requires continuous monitoring and regular therapy adjustment, which becomes challenging in conditions of limited access to face-to-face medical care, particularly during wartime. Telemedicine is considered a potentially effective alternative to traditional care; however, its effectiveness in real-world primary care settings requires further evaluation.
Objective: To compare the clinical, organizational, and patient-centered outcomes of telemedicine-based versus in-person management of atrial fibrillation in primary care, particularly in settings with limited access to in-person services.
Methods: A retrospective and prospective cohort study was conducted involving 400 patients with atrial fibrillation who received offline care before 2022 and were subsequently managed through a remote (online) model. The analysis included clinical outcomes (heart rate control, blood pressure control, recurrence rates, complications), organizational indicators (hospitalizations, frequency of healthcare provider contacts), and patient-oriented measures. Paired dichotomous changes were analyzed using the McNemar test.
Results: Transition to the online care model was associated with a statistically significant improvement in heart rate control (from 62.0% to 85.4%; p<0.001; absolute increase +23.4%) and blood pressure control (from 53.0% to 61.3%; p<0.001; +8.3%). The rate of urgent hospitalizations decreased from 22.3% to 0.25% (p<0.001), while stroke incidence declined from 6.0% to 0.5% (p=0.01). The proportion of patients with frequent AF recurrences remained stable (37.2% vs 39.4%; p>0.05), despite the impact of stress-related factors. At the same time, the rate of non-urgent medical visits increased (from 15.0% to approximately 45.0%), reflecting improved access to care. The frequency of patient–physician contacts increased to 3–4 per month. High levels of treatment adherence and patient satisfaction (78%) were observed.
Conclusion: The remote (online) management model for patients with atrial fibrillation at the primary care level is effective and safe, not inferior to traditional offline care and superior in several outcomes. Online care improves control of clinical parameters, reduces hospitalization rates, enhances access to medical services, and increases patient adherence, which is particularly important in settings with limited access to in-person care.