Risk Factor Modification for Atrial Fibrillation

Objective: The desired goal of atrial fibrillation (AF) management is maintenance of sinus rhythm in order to improve quality of life (QoL) and arrhythmia symptoms (AS). Although obesity and obstructive sleep apnea (OSA) are known risk factors for development of AF, these remain inadequately treated. We report the impact of prospectively modifying these risk factors on QoL and AS in AF patients (pts). Methods: AF pts with obesity (body mass index (BMI) ≥30kg/m 2 ) and/or the need for OSA management (high-risk as per Berlin Questionnaire or untreated OSA) were voluntarily enrolled in a nurse-led risk factor modification (RFM) program at their arrhythmia clinic visit. RFM entailed patient education, lifestyle modification counseling, coordination of care with appropriate specialists, and longitudinal care management. Progress with weight loss (WL) and OSA treatment was monitored via monthly follow-up calls and/or downloads from continuous positive airway pressure (CPAP) units for up to 12 months. QoL and AS were determined with the SF-36 and AF Severity Scale (AFSS) respectively, and were assessed at baseline, 6 months, and 12 months. Student t-test and chi-square tests were used to compare continuous and dichotomous variables. Results: From 11/1/16 to 10/31/17, 252 pts (age 63±11 years; male=179; paroxysmal AF=126) were enrolled as follows: 189 for obesity and 93 for OSA. The mean WL was 2.7±3.8% from baseline and 78% (n=126 of 162 pts with available data) of enrolled obese patients achieved WL. Among 93 pts at risk for OSA, 70 completed sleep studies and 50 were identified with OSA. Majority of these patients (76%; n=38 of 50) started CPAP therapy and have remained full (57%; n=17 of 30 pts with available CPAP data) and partial (13%; n=4 of 30) users. Table shows that SF-36 and AFSS scores improved for most measures of QoL and AS from baseline to 6 months. Conclusion: Participation in a risk factor modification program targeting obesity and obstructive sleep apnea can improve quality of life and arrhythmia symptoms in patients with atrial fibrillation. The impact of this strategy on long-term maintenance of sinus rhythm remains to be determined.

Download Full-text

Letter to the editor—pREVEntion and regReSsive Effect of weight-loss and risk factor modification on Atrial Fibrillation: the REVERSE-AF study

EP Europace ◽

10.1093/europace/euz023 ◽

2019 ◽

Vol 21 (6) ◽

pp. 990-990 ◽

Cited By ~ 1

Author(s):

Daniel O’Hare ◽

Louisa O’Neill ◽

Mark D O’Neill ◽

Steven E Williams

Keyword(s):

Atrial Fibrillation ◽

Weight Loss ◽

Risk Factor ◽

Risk Factor Modification ◽

Letter To The Editor ◽

Factor Modification

Download Full-text

Impact of a nurse‐led limited risk factor modification program on arrhythmia outcomes in patients with atrial fibrillation undergoing catheter ablation

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.14336 ◽

2020 ◽

Vol 31 (2) ◽

pp. 423-431

Author(s):

Amaryah Yaeger ◽

Brendan T. Keenan ◽

Nancy R. Cash ◽

Tara Parham ◽

Rajat Deo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Risk Factor ◽

Catheter Ablation ◽

Risk Factor Modification ◽

Factor Modification

Download Full-text

Abstract 146: Efficacy of a Nurse-Led Risk Factor Modification Program in Achieving Weight Loss in Obese Atrial Fibrillation Patients

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.11.suppl_1.146 ◽

2018 ◽

Vol 11 (suppl_1) ◽

Author(s):

Amaryah Yaeger ◽

Nancy R Cash ◽

Tara Parham ◽

Anastassia Amaro ◽

Rajat Deo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Weight Loss ◽

Risk Factor ◽

Lifestyle Modification ◽

Point Of Care ◽

Single Point ◽

Risk Factor Modification ◽

Care Approach ◽

Factor Modification

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.

Download Full-text

Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement From the American Heart Association

Circulation ◽

10.1161/cir.0000000000000748 ◽

2020 ◽

Vol 141 (16) ◽

Cited By ~ 15

Author(s):

Mina K. Chung ◽

Lee L. Eckhardt ◽

Lin Y. Chen ◽

Haitham M. Ahmed ◽

Rakesh Gopinathannair ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Risk Factor ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

Related Factors ◽

Risk Factor Modification ◽

Scientific Statement ◽

Factor Modification

Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is associated with substantial morbidity, mortality, and healthcare use. Great strides have been made in stroke prevention and rhythm control strategies, yet reducing the incidence of AF has been slowed by the increasing incidence and prevalence of AF risk factors, including obesity, physical inactivity, sleep apnea, diabetes mellitus, hypertension, and other modifiable lifestyle-related factors. Fortunately, many of these AF drivers are potentially reversible, and emerging evidence supports that addressing these modifiable risks may be effective for primary and secondary AF prevention. A structured, protocol-driven multidisciplinary approach to integrate lifestyle and risk factor management as an integral part of AF management may help in the prevention and treatment of AF. However, this aspect of AF management is currently underrecognized, underused, and understudied. The purpose of this American Heart Association scientific statement is to review the association of modifiable risk factors with AF and the effects of risk factor intervention. Implementation strategies, care pathways, and educational links for achieving impactful weight reduction, increased physical activity, and risk factor modification are included. Implications for clinical practice, gaps in knowledge, and future directions for the research community are highlighted.

Download Full-text