Adherence and Feasibility of a Multidisciplinary Lifestyle program for Patients with Atrial Fibrillation and Obesity (Preprint)

2021 ◽  
Author(s):  
Nicole Tenbult ◽  
Jos Johannes Kraal ◽  
Rutger Brouwers ◽  
Rudolph Ferdinand Spee ◽  
Sabine Eijsbouts ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medical Research ◽  
Nurse Practitioner ◽  
Medical Center ◽  
Behavioural Change ◽  
Exploratory Analysis ◽  
Completion Rates ◽  
Psychosocial Therapy ◽  
Lifestyle Program ◽  
Lifestyle Counselling

BACKGROUND Atrial Fibrillation (AF) is commonly associated with obesity. Observational studies showed that weight loss and improvement of physical fitness are associated with improved prognosis and a decrease in AF symptoms. However, despite these benefits, non-adherence is common. OBJECTIVE In this study we evaluated the adherence and feasibility of a multidisciplinary lifestyle program focusing on behavioural change in patients with AF and obesity. METHODS Patients with AF and obesity received a goal-oriented CR program for three months including 4 fixed modules: lifestyle counselling by an Advanced Nurse Practitioner, exercise training, dietary consultation and psychosocial therapy; relaxation sessions were an additional optional treatment module. After this CR program the Advanced Nurse Practitioner monitored the personal lifestyle of each individual patient 3 and 9 months of discharge CR. The primary endpoints were compliance and completion rates of the CR program, the latter being defined as performing at least of 80 % of the prescribed sessions. In addition, we performed an exploratory analysis of effects on weight and AF burden and frequency. RESULTS Ten patients with AF and obesity were recruited. The majority of patients were male (8/2), the mean age was 57.2 ± 9.0 and the BMI 32.4 ± 3.5 kg / m2. Eight patients completed the 3-months CR program. Two patients did not complete their CR program, both because of private issues. Adherence to the fixed treatment modules was 95% for lifestyle counselling, 86% for physiotherapy sessions, 88% for dietician consultations and 60% received psychosocial therapy; concerning the optional additional modules, 70% of patients were referred to the relaxation sessions and the adherence was 86%. Both weight and physical condition were improved. Frequency of AF-related symptoms was considerably reduced immediately after rehabilitation and was even lower after 1 year. Severity of AF complaints post-CR was similar to the baseline, but significantly lower after 1 year. CONCLUSIONS A one-year multidisciplinary lifestyle program was feasible in obese patients with AF with high compliance and completion rates. An exploratory analysis revealed a sustained reduction in AF symptoms, however, these results remain to be confirmed in larger studies. CLINICALTRIAL The study protocol was submitted for approval to Medical Research Ethics Committee of Máxima Medical Center (Veldhoven, the Netherlands) which confirmed that the Dutch Medical Research Involving Human Subjects Act does not apply to this study and therefore waived formal approval.

scholarly journals Feasibility of a Multidisciplinary Lifestyle Program for Obese Patients With Atrial Fibrillation

2020 ◽  
Author(s):  
Nicole Tenbult - van Limpt ◽  
JJ Kraal ◽  
RWM Brouwers ◽  
RF Spee ◽  
SCM Eijsbouts ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Physical Fitness ◽  
Behavioral Change ◽  
Dietary Advice ◽  
Obese Patients ◽  
Psychosocial Therapy ◽  
Lifestyle Program ◽  
Traditional Lifestyle ◽  
Secondary Endpoints

Abstract Aims: Atrial Fibrillation (AF) is often associated with obesity. The effects of traditional lifestyle programs are often not maintained in the longer term effects because the programs do not sufficiently focus on behavioral change. We want to study the feasibility of a multidisciplinary lifestyle program, cardiac rehabilitation (CR) focusing on behavioral change in patients with AF and obesity. Methods and results: Patients received CR for three months including exercise training, lifestyle counseling by an Advanced Nursing Specialist, dietary advice and psychosocial therapy when deemed necessary. Main endpoints were weight loss and burden of AF (AFSS questionnaire). Secondary endpoints were physical fitness (6MWT), depression (PHQ9) and anxiety (GAD7). Measurements were performed at baseline and post-CR. Weight and 6MWT were also assessed at 1-year follow-up. After following a lifestyle program, patients improved their weight and physical condition, and were less symptomatic. The frequency of AF-related symptoms was considerably reduced immediately after rehabilitation and was even lower after 1 year. The severity of AF complaints post-CR was similar to the baseline, but significantly lower after 1 year. Conclusion: A multidisciplinary lifestyle program with an emphasis on structural lifestyle improvement is feasible for obese patients with AF and potentially effective in reducing symptoms, weight and physical fitness, thereby decreasing the burden of AF.

Abstract P245: Dry Air Triggers Paroxysmal Atrial Fibrillation in Patients with Implantable Cardioverter Defibrillators

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Jennifer Nguyen ◽  
Mark S Link ◽  
Heike Luttmann-Gibson ◽  
Francine Laden ◽  
Joel Schwartz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medical Center ◽  
Absolute Humidity ◽  
Barometric Pressure ◽  
Primary Prophylaxis ◽  
Time Of Day ◽  
Weather Data ◽  
Implantable Cardioverter Defibrillators ◽  
Dual Chamber ◽  
Cardioverter Defibrillators

Introduction: Atrial fibrillation (AF) is responsible for substantial morbidity and mortality, yet little is known about the environmental factors that may trigger AF episodes. Weather has been proposed as a potential precipitant of paroxysmal AF. Hypothesis: We assessed the hypothesis that changes in outdoor ambient temperature and outdoor absolute humidity may trigger paroxysmal AF in the following 24 hours. Methods: Patients with dual chamber implantable cardioverter defibrillators (ICDs) living in eastern Massachusetts were enrolled between September 2006 and March 2010 from the Tufts Medical Center Cardiac Arrhythmia Clinic (Boston, Massachusetts) and followed prospectively for episodes of paroxysmal AF lasting at least 30 seconds. Arrhythmias documented by the ICD were reviewed and interpreted by an electrophysiologist masked to exposure. The date and time of AF episodes were linked to hourly weather data measured at Boston Logan International Airport. We examined the hypothesis using a time-stratified case-crossover analysis matched on calendar month, day of week and time of day and adjusted for air pollution and barometric pressure. To reduce the possibility of over-representation of clustered events and to reflect the averaging time of the exposure, incident AF episodes were included in the analysis if at least 24 hours had passed since the previous AF episode. Results: Of 200 patients enrolled, 49 experienced at least one AF episode (n = 328 episodes). After excluding events with missing exposure or covariate information, analyses were confined to 230 AF episodes among 47 patients. The 47 patients with paroxysmal AF were followed for an average of 1.9 years, and 32 (68%) were male, 45 (96%) were Caucasian, the mean age was 67 years, 24 (51%) had a history of prior AF episodes, 27 (57%) had a pre-implantation ejection fraction < 35%, and 29 (62%) received the ICD for primary prophylaxis. Outdoor temperature in the previous 24 hours was not associated with AF (odds ratio (OR) = 1.13; 95% confidence interval (CI): 0.89, 1.43, p = 0.32, per interquartile range (IQR) decrease of 6.3°C). Lower absolute humidity in the previous 24 hours was associated with a higher risk of AF onset (OR = 1.33; 95% CI: 1.02, 1.74, p = 0.04, per IQR decrease of 3.5 g/m 3 ); this risk increased slightly for the previous 3 hours (OR = 1.39; 95% CI: 1.06, 1.82, p = 0.02, per IQR decrease of 3.7 g/m 3 ). Conclusions: In conclusion, drier air was associated with a transiently higher risk of paroxysmal AF in the following 24 hours among patients with dual chamber ICDs.

PRIMARY MEDICAL CARE AND MEDICAL RESEARCH TRAINING

PEDIATRICS ◽  
1973 ◽  
Vol 52 (6) ◽  
pp. 768-772
Author(s):  
David G. Nathan
Keyword(s):  
Child Health ◽  
Medical Research ◽  
Medical Care ◽  
Maternal And Child Health ◽  
Medical Literature ◽  
Research Training ◽  
Medical Center ◽  
Academic Programs ◽  
Primary Medical Care ◽  
And Child Health

Dr. Cicely Williams delivered a challenging Blackfan Lecture, reproduced elsewhere in this issue of the Journal,1 at the Children's Hospital Medical Center on May 30, 1973. It should be carefully studied by all pediatricians, and particularly by pediatricians involved in academic programs. Dr. Williams speaks with the experience and wisdom gathered during more than 50 years of service to the field of maternal and child health and with unimpeachable academic credentials. She first described kwashiorkor in the Western medical literature in 1931. Dr. Williams' message to academic pediatrics is loud and clear. It may be paraphrased in the following manner: "Be off," she states, "with your ultrascience, your superspecialists and your rapt attention to the few with so called interesting illnesses.

Abstract NS12: Nursing-led Intervention to Improve Use of Prolonged Arrhythmia and Polysomnography in Veterans with Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sharon Bottomley ◽  
Lisa Keefner ◽  
Jason J Sico
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Medical Center ◽  
Length Of Hospital Stay ◽  
Lean Six Sigma ◽  
Coordinated Care ◽  
Loop Recorder ◽  
Obstructive Sleep ◽  
Hospitalization Period ◽  
Potential Benefits

Background: Current AHA/ASA ischemic stroke prevention guidelines provide updated recommendations regarding prolonged arrhythmia monitoring to detect occult atrial fibrillation and polysomnography referral (PSG) for obstructive sleep apnea (OSA) assessment. While these assessments are traditionally considered “outpatient” testing, we sought to determine the feasibility of starting these referrals during the hospitalization period. Methods: We used Lean Six Sigma process improvement methods to process map the current and future states of obtaining prolonged arrhythmia monitoring and PSG at a single VA Medical Center. Working with stakeholders in neurology, cardiology, and sleep medicine we devised standard operating procedures for obtaining referrals for these respective testing during hospitalization. A stroke nurse coordinated all referrals. Results: Our single site intervention period was from 10/1/2015 to 2/29/2016, during which 21 patients were admitted to the neurology service with an ischemic stroke. At baseline, no patients received orders by hospital discharge for prolonged arrhythmia monitoring or PSG. Potential benefits and adverse effects of testing were discussed with Veterans. Of the twelve patients (57.1%) eligible for prolonged arrhythmia monitoring, half the patients agreed to the testing and were discharged with either a Holter monitor/implantable loop recorder. Of the 18 patients (85.7%) eligible for PSG, six agreed to the testing, with one patient receiving testing during hospitalization and the remaining patients received PSG after discharge. One Veteran was diagnosed with atrial fibrillation, whereas all Veterans receiving PSG were diagnosed with varying degrees of OSA. Positive test results initiated referrals to appropriate specialists for additional management. Length of hospital stay was not increased in order to receive the additional coordinated care. Conclusions: Implementation of a nursing coordinated program designed to improve delivery of guideline concordant post stroke arrhythmia monitoring and OSA assessment could be feasibly implemented using existing infrastructure without prolonging length of stay.

Abstract 204: Echocardiographic Evidence for Systemic Atherosclerosis, Atrial Fibrillation, and Long-Term Prognosis in Stroke Patients

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Justin Pieper ◽  
Michael Ashamalla ◽  
Neil Yager ◽  
Daniel Sedhom ◽  
Khetan Gate ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hemorrhagic Stroke ◽  
Normal Sinus Rhythm ◽  
Medical Center ◽  
Academic Medical Center ◽  
Stroke Patients ◽  
Long Term Prognosis ◽  
Echocardiographic Evidence

Background: Echocardiography is routinely performed for evaluation of cardiac embolic causes in stroke patients. We sought to examine the association of echocardiographic evidence of atherosclerosis with atrial fibrillation and long-term outcomes. Materials and methods: Retrospective chart review was performed in 756 consecutive patients treated for non-hemorrhagic stroke at a single academic medical center. Transthoracic echocardiograms were reviewed for presence of mitral annular calcifications, aortic valve sclerosis, or aortic atherosclerosis. Admission ECG and telemetry recordings were evaluated for documented dysrhythmias. Mean follow up length was 46+/- 20 months. Results: A significant number (57.7%) of patients with non-hemorrhagic stroke diagnosed with atrial fibrillation had evidence of cardiac and systemic atherosclerosis on transthoracic echocardiogram, which was less likely in patients with normal sinus rhythm (35.4%) or non-sinus non-atrial fibrillation rhythms (37.1%, p<0.05). Findings of cardiac and systemic atherosclerosis were more common in older patients (75+/- 11 vs 60+/- 16 years old, p<.001), with lower BMI (27.4+/- 6.0 vs. 29+/- 6.5, p<.001), and hypertension (71.9% vs. 59.2 %, p=.002). Patients with findings of cardiac and systemic atherosclerosis were more likely to die during follow-up (56.1% vs. 43.9%, p<.001). Conclusion: In patients with non-hemorrhagic stroke, cardiac and systemic evidence of atherosclerosis was strongly associated with atrial fibrillation and portended poor long-term prognosis. In stroke patients with cardiac and systemic evidence of atherosclerosis and rhythms other than atrial fibrillation, extended ECG monitoring may be warranted.

Implementation of the Acute Care Nurse Practitioner Role

1994 ◽  
Vol 5 (3) ◽  
pp. 404-407
Author(s):  
Lynn A. Kelso ◽  
Lori M. Massaro
Keyword(s):  
Acute Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Medical Center ◽  
Care Nurse ◽  
University Of Pittsburgh ◽  
Acute Care Nurse Practitioner ◽  
The University ◽  
Pittsburgh Medical ◽  
Practitioner Role

In this article, the experiences of two new acute care nurse practitioners working at the University of Pittsburgh Medical Center arc described. Included are the experiences they encountered in initiating the role and some of the responsibilities they assumed.

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