Administrative-driven hierarchical management of atrial fibrillation on cardiovascular events: a prospective matched cohort study.

The administrative-driven hierarchical management (ADHM) refers to the management model that general practitioners act as "voluntary gatekeepers" under local government policy incentives in the non-mandatory hierarchical medical system. However, the impact of ADHM of atrial fibrillation (AF) on cardiovascular events remains unclear. We enrolled 1455 patients with AF in the ADHM cohort and 7275 in the matched usual care (UC) cohort in Shanghai, China. During the 30 months follow-up, the rate of the primary outcome (the composite of ischemic stroke, systemic embolism, myocardial infarction, major bleeding, acute heart failure and cardiovascular death) was significantly lower in the ADHM cohort than the UC cohort (hazard ratio: 0.624; 95% confidence interval=0.554-0.703; p < 0.0001). Comparisons of the secondary endpoints, including all-cause death, cardiovascular death, ischemic stroke, and acute heart failure, also favored the ADHM cohort, while non-cardiovascular death, systemic embolism, myocardial infarction, and major bleeding were similar between cohorts. The medical costs per patient per survival day were lower in the ADHM cohort. In sum, the ADHM model is effective in reducing cardiovascular events in patients with AF. Trial number: ChiCTR2000036931.