A Village Doctor-led Telehealth Supported Trial of Heart Failure Prevention in AF Patients: MIRACLE-AF 2 (Heart Failure Prevention)

This cluster randomized study aims to compare village doctor-led integrated care versus usual care to improve cardiovascular health, atrial fibrillation management, self-management adherence, and heart failure prevention among older rural patients with atrial fibrillation in China.The primary outcome at 12 months is the change in Life's Essential 8 cardiovascular health score from baseline (phase 1). The primary outcome at 36 months is a composite cardiovascular endpoint including cardiovascular death, ischemic or hemorrhagic stroke, hospitalization for worsening HF or acute coronary syndrome, and emergency department visits due to AF (phase 2) . The primary outcome at 48 months is new-incident heart-failure diagnosis (phase 3) .An extended observational follow-up, the new-incident heart-failure diagnosis observational follow-up study, will be conducted at Year 7 to evaluate long-term effects.

• Primary Outcome of Phase 1: Change in Life's Essential 8 Cardiovascular Health Score
• Primary Outcome of Phase 2: Composite Cardiovascular Outcome
• Primary Outcome of Phase 3: New-incident heart-failure diagnosis
• Primary Outcome of Extension Study: Composite cardiovascular outcome

1. Primary completion expected

   30 Dec 2033

2. Last registry update

   7 Oct 2026

3. Started

   26 Jul 2026

4. Registered

   25 Mar 2026