Atrial Fibrillation Management of Rural Elderly Patients in China: Current Realities and Emerging Challenges

Background: Rural China experiences a disproportionately high burden of atrial fibrillation (AF) among the elderly, facing three major challenges in AF management: (1) inequitable distribution of medical resources, (2) limited access to healthcare, and (3) significant variability in clinical competency among village doctors. Objective: To evaluate current realities, systemic challenges, and evidence-based solutions for AF management in rural elderly populations, focusing on village doctors' roles and telemedicine integration. Method: A narrative review was conducted using PubMed, CNKI, and Wanfang Data (2000-2025), focusing on studies related to AF management, rural healthcare, and village doctors in China. Evidence was synthesized from epidemiological surveys, policy analyses, and intervention trials, including the MIRACLE-AF cluster-randomized trial which evaluated a telemedicine-assisted model involving remote monitoring, specialist consultations, and village doctor education. Result: Rural China exhibits low AF detection rates (4.3% in high-risk elderly) and suboptimal care due to limited resources, poor patient awareness, and significant knowledge gaps among village doctors (89.6% lacking formal medical training). The MIRACLE-AF trial demonstrated significant improvements in the intervention group: higher anticoagulation adherence (85.2% vs. 20.8%) and reduced annual cardiovascular event incidence (6.2% vs. 9.6%). Rural AF prevalence (5.4% in ≥75-year-olds) correlates with aging, lifestyle factors, and healthcare disparities. Persistent urban-rural gaps exist in AF awareness (78.3% vs. 35.3%) and risk factor control. Conclusion: Enhancing village doctors' capabilities through telemedicine-supported training, coupled with policy reforms and infrastructure investment, is essential for equitable AF management. Integrating digital health platforms with traditional care offers a feasible approach to reduce rural-urban disparities, improve outcomes, and establish sustainable chronic disease management in resource-limited settings.