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- Title
Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial.
- Authors
Abed, Hany S; Wittert, Gary A; Leong, Darryl P; Shirazi, Masoumeh G; Bahrami, Bobak; Middeldorp, Melissa E; Lorimer, Michelle F; Lau, Dennis H; Antic, Nicholas A; Brooks, Anthony G; Abhayaratna, Walter P; Kalman, Jonathan M; Sanders, Prashanthan
- Abstract
<bold>Importance: </bold>Obesity is a risk factor for atrial fibrillation. Whether weight reduction and cardiometabolic risk factor management can reduce the burden of atrial fibrillation is not known.<bold>Objective: </bold>To determine the effect of weight reduction and management of cardiometabolic risk factors on atrial fibrillation burden and cardiac structure.<bold>Design, Setting, and Patients: </bold>Single-center, partially blinded, randomized controlled study conducted between June 2010 and December 2011 in Adelaide, Australia, among overweight and obese ambulatory patients (N = 150) with symptomatic atrial fibrillation. Patients underwent a median of 15 months of follow-up.<bold>Interventions: </bold>Patients were randomized to weight management (intervention) or general lifestyle advice (control). Both groups underwent intensive management of cardiometabolic risk factors.<bold>Main Outcomes and Measures: </bold>The primary outcomes were Atrial Fibrillation Severity Scale scores: symptom burden and symptom severity. Scores were measured every 3 months from baseline to 15 months. Secondary outcomes performed at baseline and 12 months were total atrial fibrillation episodes and cumulative duration measured by 7-day Holter, echocardiographic left atrial area, and interventricular septal thickness.<bold>Results: </bold>Of 248 patients screened, 150 were randomized (75 per group) and underwent follow-up. The intervention group showed a significantly greater reduction, compared with the control group, in weight (14.3 and 3.6 kg, respectively; P < .001) and in atrial fibrillation symptom burden scores (11.8 and 2.6 points, P < .001), symptom severity scores (8.4 and 1.7 points, P < .001), number of episodes (2.5 and no change, P = .01), and cumulative duration (692-minute decline and 419-minute increase, P = .002). Additionally, there was a reduction in interventricular septal thickness in the intervention and control groups (1.1 and 0.6 mm, P = .02) and left atrial area (3.5 and 1.9 cm2, P = .02).<bold>Conclusions and Relevance: </bold>In this study, weight reduction with intensive risk factor management resulted in a reduction in atrial fibrillation symptom burden and severity and in beneficial cardiac remodeling. These findings support therapy directed at weight and risk factors in the management of atrial fibrillation.<bold>Trial Registration: </bold>anzctr.org.au Identifier: ACTRN12610000497000.
- Publication
JAMA: Journal of the American Medical Association, 2013, Vol 310, Issue 19, p2050
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.2013.280521