An app-based integrated-care system with geriatric assessment did not reduce unplanned hospitalisation in older adults with atrial fibrillation

The AFFIRMO trial was a multicentre, open-label, cluster-randomised study in six European countries that tested a mobile-health integrated-care system, adapting the Atrial Fibrillation Better Care pathway and combining it with comprehensive geriatric assessment, against usual care Primary Study (Lip et al., PMID 42819749). It enrolled 1,260 older patients with atrial fibrillation and multimorbidity (mean age 74 years, 44.4% female), 634 in the intervention arm and 626 in usual care.

The primary endpoint, all-cause unplanned hospitalisation, occurred in 108 patients (17.1%) in the intervention arm and 114 (18.2%) in usual care (adjusted odds ratio 0.95, 95% confidence interval 0.61–1.49, p=0.84). App use was suboptimal: 68.5% of intervention patients (433 of 632) used it for only a third of the observation time. The population was already well managed, with 97.3% anticoagulated and a high prevalence of guideline-recommended therapies, geriatric assessment in the intervention arm documented highly preserved function, and event rates were low. The authors conclude that the system gave no incremental benefit when applied to an optimally managed population, particularly given suboptimal uptake.

This is a negative result for a technology layer in a specific setting and should not be read as evidence against comprehensive geriatric assessment. The trial is confined to atrial fibrillation, it is not a frailty-pathway trial, and the abstract reports nothing on patient-reported outcomes or on carers. It is nonetheless a rare randomised test of geriatric assessment combined with integrated care at multi-country scale, and the result is consistent with the published pattern that process measures move while patient outcomes are flat, untested or unmeasured in that a delivery layer did not change admissions. The abstract does not say whether process measures changed, so the fit is partial.

The practical reading is narrow. A digital layer added to care that is already well run, and used by patients for a third of the time, should not be expected to reduce admissions by itself.