Abstract 13752: Impact of Pre-ablation Weight Changes on Freedom From Atrial Fibrillation

Introduction: Obesity is an established risk factor for recurrent atrial fibrillation (AF) after ablation. The impact of pre-procedure weight changes on freedom from AF (FFAF) post-ablation in both obese and non-obese patients is unknown. Hypothesis: Weight gain over the year prior to AF ablation is associated with reduced FFAF. Methods: A single-center retrospective cohort study of patients undergoing AF ablation using cryoballoon (CBA) was performed. Prior to ablation, all candidates were encouraged to adopt healthy lifestyle habits according to AHA guidelines, including weight loss, by their treating physician. Inclusion criteria included availability of weight measurements 1-year prior to and at the time of CBA, and post-CBA follow up > 90 days. The primary endpoint was FFAF through 1-year after the 3-month blanking period. Results: Among 747 CBA performed from 2011-2017, 720 patients (49% male; average age 61.3 ± 10.3 years) met inclusion criteria. Of these, 241 patients (33.5%) were obese (body mass index ≥ 30) and 337 (46.8%) had non-paroxysmal AF. There were 9.5 ± 2.8 freezes per patient and 99 patients had additional ablation lesion sets delivered. Overall, FFAF was observed in 506 (70.3%) patients at 15 months. Multivariate analysis revealed that weight loss (p<0.001), paroxysmal AF (p=0.036), shorter duration of AF diagnosis (p=0.022) and absence of AF during the 90-day blanking period (p<0.001) were associated with FFAF. Kaplan-Meier estimates of FFAF by pre-ablation weight changes in obese and non-obese patients are shown in Figure 1a-b. In obese and non-obese patients, weight loss was associated with FFAF in a dose- dependent and binary manner, respectively. Conclusions: Weight gain in the year prior to AF ablation was associated with lower rates of FFAF regardless of baseline BMI. Patient directed weight loss should be encouraged prior to AF ablation.

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Body weight and return to work among survivors of early-stage breast cancer

ESMO Open ◽

10.1136/esmoopen-2020-000908 ◽

2020 ◽

Vol 5 (6) ◽

pp. e000908

Author(s):

Antonio Di Meglio ◽

Gwenn Menvielle ◽

Agnes Dumas ◽

Arnauld Gbenou ◽

Sandrine Pinto ◽

...

Keyword(s):

Breast Cancer ◽

Weight Loss ◽

Body Weight ◽

Weight Gain ◽

Return To Work ◽

Normal Weight ◽

Psychosocial Treatment ◽

Obese Patients ◽

Weight Changes ◽

The Impact

BackgroundMany breast cancer (BC) survivors are employed at diagnosis and are expected to return to work after treatment. Among them, around 50% are overweight or obese. There are limited data about the impact of body weight on their ability to return to work.MethodsWe used data from CANcer TOxicity (NCT01993498), a prospective, multicentre cohort of women with stage I–III BC. Professionally active women who were ≥5 years younger than retirement age were identified. Multivariable logistic regression models examined associations of body mass index (BMI) at diagnosis and subsequent weight changes with non-return to work 2 years after diagnosis, adjusting for psychosocial, treatment and behavioural characteristics.ResultsAmong 1869 women, 689 were overweight or obese. Overall, 398 patients (21.3%) had not returned to work 2 years after diagnosis. Non-return to work was more likely for overweight or obese than underweight or normal weight patients (adjusted OR (aOR) 1.32; 95% CI, 1.01 to 1.75; p=0.045). Weight loss (≥5%) was observed in 15.7% overweight or obese and 8.7% underweight or normal weight patients and was associated with significant increases in physical activity only among overweight or obese patients (mean change, +4.7 metabolic-equivalent-of-task-hour/week; 95% CI +1.9 to +7.5). Overweight or obese patients who lost weight were more likely to return to work compared with those who did not lose weight (aOR of non-return-to-work, 0.48; 95% CI 0.24 to 0.97, p=0.0418), whereas weight loss was associated with increased odds of non-return to work among underweight or normal weight women (aOR 2.07; 95% CI 1.20 to 3.56, p=0.0086) (pinteractionBMI×weight changes=0.0002). The continuous trend of weight gain on non-return to work was significant for overweight or obese patients (aOR for one-percent-unit difference, 1.03; 95% CI 1.01 to 1.06, p=0.030).ConclusionsExcess weight may be a barrier to return to work. Among overweight or obese BC survivors, weight loss was associated with higher rates of return to work, whereas further weight gain was associated with lower likelihood of return to work. Employment outcomes should be evaluated in randomised studies of weight management.

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P1908Left common pulmonary vein in atrial fibrillation ablation with cryoballoon. A meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehz748.0655 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

V Gionti ◽

M C Negro ◽

M Longobardi ◽

C Storti

Keyword(s):

Atrial Fibrillation ◽

Clinical Outcome ◽

Pulmonary Vein ◽

Meta Analysis ◽

Cochrane Library ◽

Cryoballoon Ablation ◽

Inclusion Criteria ◽

Af Ablation ◽

The Impact ◽

Common Pulmonary Vein

Abstract Background Conflicting results regarding the impact of left common pulmonary (LCPV) vein on clinical outcome of atrial fibrillation (AF) ablation with cryoballoon technology have been reported. In the present study, we sought to investigate the performance of the 28 mm cryoballoon advance (CB-A) on left common pulmonary vein (LCPV) in terms of post procedural outcome. Methods We systematically searched on PubMed and Cochrane library for the articles that compared the recurrence rate of AF after cryoballoon ablation between patients with four separate and distinct pulmonary vein ostia and with LCPV. Results A total of 5 studies with 1052 patients met our predefined inclusion criteria. Recurrence of AF after CB-A ablation was similar in both groups (Log OR 0.45; 95% CI: −0.03, 0.94; I=48%, p=0.08), Fig 1. Figure 1 Conclusion LCPV doesn't affect clinical outcome of AF ablation with cryoballoon technology.

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REPORTED WEIGHT CHANGE IN OLDER ADULTS AND PRESENCE OF FRAILTY

Journal of Frailty & Aging ◽

10.14283/jfa.2019.44 ◽

2019 ◽

pp. 1-8

Author(s):

R.S. Crow ◽

C.L. Petersen ◽

S.B. Cook ◽

C.J. Stevens ◽

A.J. Titus ◽

...

Keyword(s):

Older Adults ◽

Weight Loss ◽

Weight Gain ◽

Weight Change ◽

Primary Outcome ◽

Weight Changes ◽

Health And Nutrition ◽

The Impact ◽

Current Weight ◽

Time Point

Objective: A 5% change in weight is a significant predictor for frailty and obesity. We ascertained how self-reported weight change over the lifespan impacts rates of frailty in older adults. Methods: We identified 4,984 subjects ≥60 years with body composition measures from the National Health and Nutrition Examination Survey. An adapted version of Fried’s frailty criteria was used as the primary outcome. Self-reported weight was assessed at time current,1 and 10 years earlier and at age 25. Weight changes between each time point were categorized as ≥ 5%, ≤5% or neutral. Logistic regression assessed the impact of weight change on the outcome of frailty. Results: Among 4,984 participants, 56.5% were female, mean age was 71.1 years, and mean BMI was 28.2kg/m2. A weight loss of ≥ 5% had a higher association with frailty compared to current weight, age 25 (OR 2.94 [1.72,5.02]), 10 years ago (OR 1.68 [1.05,2.69]), and 1 year ago (OR 1.55 [1.02,2.36]). Weight gain in the last year was associated with increased rate of frailty (1.59 [1.09,2.32]). Conclusion: There is an association between frailty and reported weight loss over time while only weight gain in the last year has an association with frailty.

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Association between pre-ablation bariatric surgery and atrial fibrillation recurrence in morbidly obese patients undergoing atrial fibrillation ablation

EP Europace ◽

10.1093/europace/euz183 ◽

2019 ◽

Vol 21 (10) ◽

pp. 1476-1483 ◽

Cited By ~ 19

Author(s):

Eoin Donnellan ◽

Oussama M Wazni ◽

Mohamed Kanj ◽

Bryan Baranowski ◽

Paul Cremer ◽

...

Keyword(s):

Atrial Fibrillation ◽

Bariatric Surgery ◽

Propensity Score ◽

Multivariable Analysis ◽

Morbidly Obese ◽

Obese Patients ◽

Af Ablation ◽

The Impact ◽

Af Recurrence

Abstract Aims Obesity decreases arrhythmia-free survival after atrial fibrillation (AF) ablation by mechanisms that are not fully understood. We investigated the impact of pre-ablation bariatric surgery (BS) on AF recurrence after ablation. Methods and results In this retrospective observational cohort study, 239 consecutive morbidly obese patients (body mass index ≥40 kg/m2 or ≥35 kg/m2 with obesity-related complications) were followed for a mean of 22 months prior to ablation. Of these patients, 51 had BS prior to ablation, and our primary outcome was whether BS was associated with a lower rate of AF recurrence during follow-up. Adjustment for confounding was performed with multivariable Cox proportional hazard models and propensity-score based analyses. During a mean follow-up of 36 months after ablation, 10/51 patients (20%) in the BS group had recurrent AF compared with 114/188 (61%) in the non-BS group (P < 0.0001). In the BS group, 6 patients (12%) underwent repeat ablation compared with 77 patients (41%) in the non-BS group, (P < 0.0001). On multivariable analysis, the association between BS and lower AF recurrence remained significant. Similarly, after weighting and adjusting for the inverse probability of the propensity score, BS was still associated with a lower hazard of AF recurrence (hazard ratio 0.14, 95% confidence interval 0.05–0.39; P = 0.002). Conclusion Bariatric surgery is associated with a lower AF recurrence after ablation. Morbidly obese patients should be considered for BS prior to AF ablation, though prospective multicentre studies should be performed to confirm our novel finding.

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Long-term cardiovascular outcomes of patients with extreme obesity following atrial fibrillation ablation

EP Europace ◽

10.1093/europace/euab116.227 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

REES Adomako ◽

JASON Payne ◽

W Schleifer ◽

FARIS Khan ◽

ARTHUR Easley ◽

...

Keyword(s):

Atrial Fibrillation ◽

Perioperative Complications ◽

Adverse Outcomes ◽

Obese Patients ◽

Extreme Obesity ◽

Long Term Outcomes ◽

Af Ablation ◽

Obstructive Sleep ◽

Recurrent Atrial Fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Obesity and extreme obesity increase risk of recurrent atrial fibrillation (AF) and perioperative complications following AF ablation. However, long-term outcomes following AF ablation among obese patients is unknown. Purpose To examine long-term cardiovascular (CV) mortality and hospitalization among obese patients undergoing AF ablation Methods This retrospective study included 830 consecutive patients undergoing AF ablation from January 2013 to June 2019 at a tertiary referral medical center. Patients with obesity defined as body mass index (BMI) ≥30-39.9 kg/m2 and a subgroup of patients with extreme obesity with BMI ≥40 kg/m2 were identified. Patients were monitored for mortality and hospitalization during a median follow-up time of 819 days. Multivariate model adjusting for CHA2DS2-VASc score and history of obstructive sleep apnea (OSA) was performed. Results Mean age was 62 ± 10 years and 67.5% were male. Obese patients (n = 493, 59%) had a higher CHA2DS2-VASc score, and greater prevalence of OSA. These patients tended to have higher all-cause mortality and hospitalization (adjusted HR, 1.21 95% CI 0.98 to 1.51; P = 0.078), as well as greater non-CV outcomes (adjusted HR 1.45, 95% CI 1.02 to 2.08; P = 0.04). However, CV death and admission were comparable among patients with and without obesity (adjusted HR 1.14, 95% CI 0.90 to 1.45; P = 0.28). A subgroup of 111 (13.4%) extremely obese patients were identified. In comparison with obese patients with BMI ≥30-39.9 kg/m2, patients with extreme obesity with BMI ≥40 kg/m2 had similar CV (adjusted HR 1.07, 95% CI 0.75 to 1.50; P = 0.70) and non-CV adverse outcomes (adjusted HR 1.11, 95% CI 0.69 to 1.72; P = 0.65), Figure. Conclusions Obesity is not associated with increased CV mortality or admission following AF ablation. Non-CV events are the major cause of adverse outcomes among obese patients. Identification and reversal, where possible, of non-CV comorbidity may result in improved long-term outcomes following AF ablation. In addition, extremely obese patients with BMI≥40 kg/m2 pose a similar risk of having adverse outcomes to obese patients with BMI≥30-39.9 kg/m2. Thus, patients with extreme obesity should not be excluded from catheter ablation as a management option of AF based solely on their BMI. Abstract Figure. Cumulative-Incidence Curves

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Waitlist Weight Changes Impact Survival Following Heart Transplantation

10.22541/au.161152066.63991526/v1 ◽

2021 ◽

Author(s):

Nicholas Hess ◽

Ryan Tedford ◽

Brian Houston ◽

Nicolas Pope ◽

Lucas Witer ◽

...

Keyword(s):

Weight Loss ◽

Weight Gain ◽

Heart Transplantation ◽

Weight Change ◽

Secondary Analysis ◽

Orthotopic Heart Transplantation ◽

Weight Changes ◽

One Year ◽

The Impact ◽

United Network

Background: This study investigated the impact of weight change in waitlisted candidates on posttransplant outcomes following orthotopic heart transplantation (OHT). Methods: The United Network for Organ Sharing database was queried to identify adult patients undergoing isolated, primary OHT from 1/1/2010 to 3/20/2020. Patients were stratified into 3 cohorts based on percent weight change from listing to OHT. The primary outcome was one-year survival, and multivariable modeling was used for risk-adjustment. A secondary analysis compared outcomes of recipients waitlisted ≥90 days. Results: A total of 22,360 patients were included, 18,826 (84.2%) with stable weight, 1,672 (7.5%) with ≥5% weight loss, and 1,862 (8.3%) with ≥5% weight gain. Median age was similar across cohorts. Waitlist time was longest in patients with weight gain and shortest in those with stable weight (417 vs 74 days, P<0.001). The weight loss cohort had higher rates of dialysis dependency, pacemaker, and drug-treated acute rejection at one year (all P<0.05). Ninety-day and one-year posttransplant survival was lowest in the weight loss cohort. Multivariable modeling identified both ≥5% weight loss (HR 1.26, 95% CI 1.07-1.48) and decreasing weight (per 1%, HR 1.02, 95% CI 1.01-1.03) as risk-adjusted predictors of one-year mortality. In sub-analysis of recipients waitlisted ≥90 days, ≥5% weight loss and decreasing weight remained significant independent predictors for mortality. Conclusion: Waitlisted OHT candidates with ≥5% weight loss comprised a small, but higher-risk population with increased rates of postoperative complications and decreased survival. Efforts focused on nutritional optimization and preventing weight loss while awaiting OHT appear warranted.

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Managing Obesity in Lockdown: Survey of Health Behaviors and Telemedicine

Nutrients ◽

10.3390/nu13041359 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1359

Author(s):

Noga C Minsky ◽

Dafna Pachter ◽

Galia Zacay ◽

Naama Chishlevitz ◽

Miriam Ben-Hamo ◽

...

Keyword(s):

Weight Loss ◽

Body Weight ◽

Weight Gain ◽

Health Behaviors ◽

Online Survey ◽

Eating Patterns ◽

Weight Changes ◽

Exercise Habits ◽

Prevent Weight Gain ◽

Vegetables And Fruits

Since the outbreak of COVID-19, billions of people have gone into lockdown, facing pandemic related challenges that engender weight gain, especially in the obese. We report the results of an online survey, conducted during Israel’s first quarantine, of 279 adults treated in hospital-based obesity clinics with counseling, medications, surgery, endoscopic procedures, or any combination of these for weight loss. In this study, we assessed the association between changes in dietary and lifestyle habits and body weight, and the benefits of receiving weight management care remotely through telemedicine during lockdown. Compared to patients not receiving obesity care via telemedicine, patients receiving this care were more likely to lose weight (OR, 2.79; p = 0.042) and also to increase participation in exercise (OR, 2.4; p = 0.022). While 40% of respondents reported consuming more sweet or salty processed snacks and 33% reported less vegetables and fruits, 65% reported more homemade foods. At the same time, 40% of respondents reported a reduction in exercise and 52% reported a decline in mood. Alterations in these eating patterns, as well as in exercise habits and mood, were significantly associated with weight changes. This study highlights that lockdown affects health behaviors associated with weight change, and advocates for the use of telemedicine to provide ongoing obesity care during future quarantines in order to promote weight loss and prevent weight gain.

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Growth and seasonal weight changes as they relate to spring and autumn set points in mule deer

Canadian Journal of Zoology ◽

10.1139/z91-107 ◽

1991 ◽

Vol 69 (3) ◽

pp. 744-747 ◽

Cited By ~ 18

Author(s):

Lyle A. Renecker ◽

W. M. Samuel

Keyword(s):

Growth Rate ◽

Weight Loss ◽

Weight Gain ◽

Mule Deer ◽

Odocoileus Hemionus ◽

Weight Changes ◽

Annual Cycles ◽

Body Weights ◽

Compensatory Gain ◽

Highly Correlated

Growth rate and potential, 25 hand-reared mule deer (Odocoileus hemionus hemionus) were examined. When possible, body weights of all animals were recorded weekly. Female deer matured faster than males, but males attained a larger body size. Regressions of winter weight loss of both sexes on peak autumn weight were highly correlated. Similarly, spring and summer compensatory gain in females could be predicted from the minimum spring weight. Annual cycles of intake and weight gain may have adaptations that improve reproductive success and winter survival.

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S90. A SYSTEMATIC REVIEW AND META-ANALYSIS OF PHARMACOLOGICAL INTERVENTIONS FOR REDUCTION OF WEIGHT GAIN IN PEOPLE WITH SCHIZOPHRENIA: 2019 UPDATE

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.156 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S68-S68

Author(s):

Sri Mahavir Agarwal ◽

Nicolette Stogios ◽

Zohra Ahsan ◽

Jonathan Lockwood ◽

Markus Duncan ◽

...

Keyword(s):

Weight Loss ◽

Weight Gain ◽

Adverse Effects ◽

Randomized Controlled Trials ◽

First Episode ◽

Controlled Trials ◽

Inclusion Criteria ◽

Pharmacological Interventions ◽

Randomized Controlled ◽

Modest Weight Loss

Abstract Background Weight gain and obesity are common problems encountered by patients with schizophrenia. This is partially attributable to use of second-generation antipsychotics that are associated with weight gain and other metabolic disturbances. The significance of this prevalence and its impact on premature mortality and morbidity requires better consensus on its management. The objective of this review is to determine the effects of adjunctive pharmacological interventions aimed at reducing weight gain in schizophrenia. Methods We searched the Cochrane Schizophrenia Group’s Trials Register which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. Inclusion criteria consisted of all randomized controlled trials examining any adjunctive pharmacological intervention for weight loss in patients with schizophrenia or schizophrenia-like illnesses. The primary outcome of each study had to be body weight or a weight related measure. We reliably selected, quality assessed, and extracted data from studies. As endpoint and change data was combined in the analysis, mean differences (MD) of the change from baseline were calculated using Review Manager 5.3. Results Sixty-one randomized controlled trials met inclusion criteria for this review (pooled n = 3328). Metformin is effective in bringing about modest weight loss (Weight: MD -3.40 kg, 95% CI -4.63 to -2.16; participants = 731; studies = 12; BMI: MD -1.39, 95% CI -1.94 to -0.85; participants = 879; studies = 13). Heterogeneity was reduced by dividing populations into first episode psychosis (FEP) and chronic populations, where FEP patients appeared to benefit most from early metformin intervention (Weight: MD -5.18 kg, 95% CI -6.22 to -4.14; BMI: MD -1.87 kg/m2, 95% CI -2.19 to -1.56; participants = 214; studies = 3) as compared to chronic patients (Weight: MD -2.22 kg, 95% CI -3.07 to -1.37; participants = 517; studies = 9; BMI: MD -1.18 kg/m2, 95% CI -1.89 to -0.48; participants = 665; studies = 10). However, ethnicity could be a confounder for the apparent effect of illness stage, as all first episode metformin intervention studies were conducted in patients with Chinese ethnicity. Metformin as a treatment for weight gain may be associated with additional adaptive changes in fasting insulin levels and insulin resistance. The frequency of adverse effects did not differ between metformin and placebo groups. Moreover, glucagon-like peptide agonists (GLP-1RAs), such as liraglutide and exenatide, were also effective in reducing weight (Weight: MD -3.95 kg, 95% CI -7.08 to -0.83; participants = 165; studies = 3; BMI -1.26 kg/m2, 95% CI -2.21 to -0.30; participants = 165; studies = 3; waist circumference: MD -3.25, 95% CI -5.93 to -0.57; participants = 165, studies = 3). The frequency of adverse effects did not differ between GLP-1RA and placebo groups. Topiramate 200 mg was also effective for weight reduction (Weight: MD=-6.61 kg, 95% CI -9.62 to -3.61; BMI: MD=-2.72, 95% CI -3.25 to -2.20; participants = 181, studies = 3). Discussion This review highlights the promise of pharmacological interventions for decreasing weight gain associated with antipsychotic use. Of the drugs studied, metformin has the most evidence and was most effective in bringing about modest weight loss. Topiramate and GLP-1RA also have accumulating evidence supporting efficacy in reducing weight. Interpretation for other agents is limited by the small number of studies, sample size, and short study duration. Future studies that are adequately powered, with longer treatment duration, will be needed in evaluating the efficacy and safety of interventions for managing weight gain further.

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Towards Precision Health in Weight Reduction: Thematic Content Analysis of an Open-Ended Survey on Reasons Why Morbidly Obese Patients Want to Lose Weight.

10.21203/rs.3.rs-42745/v1 ◽

2020 ◽

Author(s):

Mazapuspavina Md-Ya ◽

Ilham Ameera Ismail ◽

Khasnur Abd Malek ◽

Khalid Yusoff ◽

Awang Bulgiba

Keyword(s):

Morbid Obesity ◽

Weight Loss ◽

Content Analysis ◽

Weight Reduction ◽

Extensive Study ◽

Morbidly Obese ◽

Obese Patients ◽

Thematic Content Analysis ◽

Thematic Content ◽

The Impact

Abstract Background: Addressing individuals’ motivation to lose weight among patients with morbid obesity is an essential entity in weight reduction. Failures to shift motivation into weight loss actions are common. These could be contributed by the inadequacy to identify and subsequently address the key reasons, that are of particular concern to the patient' individual needs. We aimed to understand the motivations better and identify the reasons why morbidly obese patients attending hospital-based weight management programmes (WMP) wanted to lose weight. Methods: The study used a qualitative approach to analyze part of a quantitative questionnaire of a more extensive study to understand factors influencing weight loss among morbidly obese patients. We used thematic content analysis to analyze responses from a self-administered open-ended question "What is the main factor why you want to lose your weight?”. A total of 225 new patients attending obesity clinics in two tertiary hospitals responded to the questionnaire. Results: Patients’ mean BMI was 45.6±8.05 kg/m2. Four themes emerged for the reasons why morbidly obese patients wanted to lose weight. Health was the most commonly inferred theme (84%). Patients were concerned about the impact obesity had on their health. Overcoming obesity was seen as a reward not just for physical health, but also for their psychological wellbeing. Patients regard being functional to care for themselves, their family members, as well as their religious and career needs as the next most crucial theme (25.8%). Patients raised the theme appearance (12.9%), especially with regards to wanting to look and feel beautiful. The last theme was perceived stigmatization for being morbidly obese as they were mocked and laughed at for their appearance (3.1%).Conclusion: Patients with morbid obesity in this study had expressed their main personal motivational reasons to lose weight. Concerns about the impact of morbid obesity on health, physical, social and obligatory function, appearance and perceived stigma warrant detailed exploration by the managing health professionals. Identifying and addressing these unique personal motivations in a focused approach is vital at the beginning and throughout a weight reduction program in this unique group.

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