scholarly journals Effect of weight loss and risk factor management on pericardial fat and cardiac structure in-patients with atrial fibrillation

2015 ◽  
Vol 24 ◽  
pp. S339
Author(s):  
R. Pathak ◽  
A. Nelson ◽  
M. Meredith ◽  
A. Carbone ◽  
A. Mehta ◽  
...  
Author(s):  
Saad Javed ◽  
Dhiraj Gupta ◽  
Gregory Y H Lip

Abstract The global prevalence of obesity has reached epidemic proportions, paralleled by a rise in cases of atrial fibrillation (AF). Data from epidemiological cohorts support the role of obesity as an independent risk factor for AF. Increasing evidence indicates that obesity may contribute to the AF substrate through a number of pathways including by altering epicardial adipose tissue biology, inflammatory pathways, structural cardiac remodelling, and inducing atrial fibrosis. Due to changes in pharmacokinetics and pharmacodynamics, specific therapeutic considerations are required to guide management of patients with AF including anticoagulation and rhythm control. Also, weight loss in patients with AF has been associated with reduced progression from paroxysmal to persistent AF and indeed regression from persistent to proximal AF. However, the role of dietary intervention in AF control remains to be fully elucidated and hard prospective outcome data to support weight loss are required in AF to determine its role as part of a comprehensive risk factor management strategy for AF in obese patients.


EP Europace ◽  
2018 ◽  
Vol 20 (12) ◽  
pp. 1929-1935 ◽  
Author(s):  
Melissa E Middeldorp ◽  
Rajeev K Pathak ◽  
Megan Meredith ◽  
Abhinav B Mehta ◽  
Adrian D Elliott ◽  
...  

Author(s):  
Elena Arbelo ◽  
Suleman Aktaa ◽  
Andreas Bollmann ◽  
André D’Avila ◽  
Inga Drossart ◽  
...  

Abstract Aims To develop quality indicators (QIs) that may be used to evaluate the quality of care and outcomes for adults with atrial fibrillation (AF). Methods and results We followed the ESC methodology for QI development. This methodology involved (i) the identification of the domains of AF care for the diagnosis and management of AF (by a group of experts including members of the ESC Clinical Practice Guidelines Task Force for AF); (ii) the construction of candidate QIs (including a systematic review of the literature); and (iii) the selection of the final set of QIs (using a modified Delphi method). Six domains of care for the diagnosis and management of AF were identified: (i) Patient assessment (baseline and follow-up), (ii) Anticoagulation therapy, (iii) Rate control strategy, (iv) Rhythm control strategy, (v) Risk factor management, and (vi) Outcomes measures, including patient-reported outcome measures (PROMs). In total, 17 main and 17 secondary QIs, which covered all six domains of care for the diagnosis and management of AF, were selected. The outcome domain included measures on the consequences and treatment of AF, as well as PROMs. Conclusion This document defines six domains of AF care (patient assessment, anticoagulation, rate control, rhythm control, risk factor management, and outcomes), and provides 17 main and 17 secondary QIs for the diagnosis and management of AF. It is anticipated that implementation of these QIs will improve the quality of AF care.


Author(s):  
Amaryah Yaeger ◽  
Nancy R Cash ◽  
Tara Parham ◽  
Anastassia Amaro ◽  
Rajat Deo ◽  
...  

Objective: Weight loss (WL) can improve arrhythmia outcomes in obese patients (pts) with atrial fibrillation (AF). Although WL in this population has been achieved by strict dietary and lifestyle modification in physician-led research protocols, these resource intensive strategies have limited real-life applicability. We report the efficacy of a pragmatic outpatient based nurse-led risk factor modification (RFM) program that utilizes a high-touch, single point of care approach for achieving WL in AF pts at a tertiary care arrhythmia program. Methods: All new AF pts with obesity (defined as body mass index (BMI) ≥30kg/m 2 ) were offered enrollment. The pragmatic approach to WL focused on patient engagement and education, motivational interviewing, development of individualized lifestyle modification goals to improve dietary and exercise habits, and longitudinal telephonic care management to reinforce these changes. WL and compliance with established goals were assessed during ongoing biweekly (initial 2 months) then monthly follow-up support calls for up to 12 months. Continuing participation in RFM program was on a voluntary basis. Pts unable to achieve ≥3% WL by 3 months were referred for escalated care to a WL physician specialist. Pts who declined participation served as controls. Student t-test and chi-square tests were used to compare continuous and dichotomous variables. Results: Between 11/1/16 to 10/31/17, 189 pts (BMI 36.3±6) enrolled in RFM program, and 115 pts (BMI 35.5±5.4; P=NS) declined participation. The majority of enrolled pts (72%, n=136 of 189) had failed ≥1 previous WL attempts. Follow-up WL data (5.5±4.1 months for enrolled; 5.2±2.9 months for declined; P=NS) was available and compared in 162 enrolled (86%, n=162 of 189) and 59 declined (51%, n=59 of 115) pts. Pts enrolled in RFM program achieved significantly greater WL than declined pts (2.7±3.8% vs. 0.3±3.5%, respectively; p<0.05). See table for details. Conclusions: A pragmatic nurse-led risk factor modification strategy focusing on lifestyle changes reinforced by frequent patient follow-up can be effective in achieving weight loss in obese atrial fibrillation patients. This single point of care approach is a potentially sustainable model for maintaining weight loss in this population.


2017 ◽  
Vol 26 (9) ◽  
pp. 990-997 ◽  
Author(s):  
Rajiv Mahajan ◽  
Rajeev K. Pathak ◽  
Anand Thiyagarajah ◽  
Dennis H. Lau ◽  
Francis E. Marchlinski ◽  
...  

2020 ◽  
Vol 43 (11) ◽  
pp. 1232-1239 ◽  
Author(s):  
Astrid N. L. Hermans ◽  
Rachel M. J. Velden ◽  
Monika Gawalko ◽  
Dominique V. M. Verhaert ◽  
Lien Desteghe ◽  
...  

2013 ◽  
Vol 61 (10) ◽  
pp. E2117
Author(s):  
Hany S. Abed ◽  
Adam Nelson ◽  
Darryl Leong ◽  
James D. Richardson ◽  
Rajiv Mahajan ◽  
...  

2017 ◽  
Vol 3 (5) ◽  
pp. 436-447 ◽  
Author(s):  
Rajeev K. Pathak ◽  
Michelle Evans ◽  
Melissa E. Middeldorp ◽  
Rajiv Mahajan ◽  
Abhinav B. Mehta ◽  
...  

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