{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T08:55:45Z","timestamp":1791449745733,"version":"4.3.3"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Key Clinical Study Project of Jiangsu Province","award":["BE2017750"],"award-info":[{"award-number":["BE2017750"]}]},{"name":"Clinical Medicine Expert Team Project of Xuzhou","award":["2019208002"],"award-info":[{"award-number":["2019208002"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Cognitive impairment is common among older patients with atrial fibrillation (AF). We aimed to evaluate whether baseline cognitive function modifies the effectiveness of a telemedicine-based, village doctor-led integrated care in older patients with AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a post hoc subgroup analysis of the MIRACLE-AF cluster-randomized trial conducted across 30 village clinics in China from December 2020 to May 2024. Rural participants aged \u226565 years with AF received telemedicine-based, village doctor-led integrated AF care or usual care. Participants were categorized by baseline Mini-Mental State Examination (MMSE) score into severe cognitive impairment (MMSE &amp;lt; 18), mild-to-moderate cognitive impairment (MMSE 18\u201323), and preserved cognition (MMSE \u2265 24). The primary outcome was a composite of cardiovascular death, all strokes, hospitalization for worsening heart failure or acute coronary syndrome, and emergency visits for AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1039 participants enrolled in the MIRACLE-AF trial [mean (SD) age, 75.8 (5.7) years; 460 women (44.3%)], 1028 (98.9%) had baseline MMSE assessed (388 with MMSE &amp;lt; 18, 305 with MMSE 18\u201323, and 335 with MMSE \u2265 24). Compared with control, the intervention reduced the risk of the primary outcome among patients with MMSE 18\u201323 [adjusted hazard ratio (HR), 0.56; 95% CI, 0.34\u20130.92], MMSE \u2265 24 (adjusted HR, 0.55; 95% CI, 0.32\u20130.93), and MMSE &amp;lt; 18 (adjusted HR, 0.86; 95% CI, 0.54\u20131.35). P for interaction was 0.336.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A telemedicine-based, village doctor-led integrated care model was associated with favourable outcomes across baseline cognitive strata, warranting further evaluation among cognitively vulnerable adults with AF in rural settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov (identifier NCT04622514).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euag233","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T12:44:53Z","timestamp":1787921093000},"source":"Crossref","is-referenced-by-count":0,"title":["Cognitive function and telemedicine-based, village doctor-led care for atrial fibrillation"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8755-6965","authenticated-orcid":false,"given":"Mingfang","family":"Li","sequence":"first","affiliation":[{"name":"Division of Cardiology, The First Affiliated Hospital with Nanjing Medical University , 300 Guangzhou Road, Nanjing 210029 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2808-6286","authenticated-orcid":false,"given":"Yang","family":"Chen","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital , Liverpool ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shimeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, The First Affiliated Hospital with Nanjing Medical University , 300 Guangzhou Road, Nanjing 210029 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Chu","sequence":"additional","affiliation":[{"name":"Division of Cardiology, The First Affiliated Hospital with Nanjing Medical University , 300 Guangzhou Road, Nanjing 210029 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5901-780X","authenticated-orcid":false,"given":"Shu","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, The First Affiliated Hospital with Nanjing Medical University , 300 Guangzhou Road, Nanjing 210029 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3449-821X","authenticated-orcid":false,"given":"Youmei","family":"Shen","sequence":"additional","affiliation":[{"name":"Division of Cardiology, The First Affiliated Hospital with Nanjing Medical University , 300 Guangzhou Road, Nanjing 210029 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y H","family":"Lip","sequence":"additional","affiliation":[{"name":"Institute of Life Course and Medical Sciences, University of Liverpool , William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX ,","place":["UK"]},{"name":"Department of Clinical Medicine, Aalborg University , Aalborg ,","place":["Denmark"]},{"name":"Department of Cardiology, Lipidology and Internal Medicine with Intensive Coronary Care Unit, Medical University of Bialystok , Bialystok ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9844-486X","authenticated-orcid":false,"given":"Minglong","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Cardiology, The First Affiliated Hospital with Nanjing Medical University , 300 Guangzhou Road, Nanjing 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