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Original Investigation |

Effect of Weight Reduction and Cardiometabolic Risk Factor Management on Symptom Burden and Severity in Patients With Atrial Fibrillation:  A Randomized Clinical Trial

Hany S. Abed, BPharm, MBBS1,2; Gary A. Wittert, MBBch, MD2; Darryl P. Leong, MBBS, MPH, PhD1; Masoumeh G. Shirazi, MD1; Bobak Bahrami, MBBS1; Melissa E. Middeldorp1; Michelle F. Lorimer, BSc3; Dennis H. Lau, MBBS, PhD1; Nicholas A. Antic, MBBS, PhD4; Anthony G. Brooks, PhD1; Walter P. Abhayaratna, MBBS, PhD5; Jonathan M. Kalman, MBBS, PhD6; Prashanthan Sanders, MBBS, PhD1
[+] Author Affiliations
1Centre for Heart Rhythm Disorders, University of Adelaide, and Royal Adelaide Hospital, Adelaide, Australia
2Department of Medicine, University of Adelaide, and Royal Adelaide Hospital, Adelaide, Australia
3Data Management and Analysis Centre, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia
4Adelaide Institute for Sleep Health, Repatriation General Hospital, Adelaide, Adelaide, Australia
5College of Medicine, Biology and Environment, Australian National University and Canberra Hospital, Canberra, Australia
6Department of Cardiology, Royal Melbourne Hospital, and the Department of Medicine, University of Melbourne, Melbourne, Australia
JAMA. 2013;310(19):2050-2060. doi:10.1001/jama.2013.280521.
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Importance  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.

Objective  To determine the effect of weight reduction and management of cardiometabolic risk factors on atrial fibrillation burden and cardiac structure.

Design, Setting, and Patients  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.

Interventions  Patients were randomized to weight management (intervention) or general lifestyle advice (control). Both groups underwent intensive management of cardiometabolic risk factors.

Main Outcomes and Measures  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.

Results  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).

Conclusions and Relevance  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.

Trial Registration  anzctr.org.au Identifier: ACTRN12610000497000

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Figures

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Figure 1.
Patient Recruitment, Attrition, and Retention

BMI indicates body mass index; INR, international normalized ratio.

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Figure 2.
Changes in Waist Circumference and Body Mass Index From Baseline (Enrollment) to 15 Months’ Follow-up

Error bars indicate 95% confidence intervals. BMI indicates body mass index, calculated as weight in kilograms divided by height in meters squared. A, Between-group level of significance: P = .21 at time 0, P = .01 at 3 months, P < .001 at 6, 9, 12, and 15 months. B, Between-group level of significance: P = .13 at time 0, P < .001 at 3, 6, 9, 12, and 15 months.

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Figure 3.
Changes in Atrial Fibrillation Symptom Scale (AFSS) Scores Over Study Follow-up

Error bars indicate 95% confidence intervals. A, Between-group level of significance: P = .41 at time 0, P = .12 at 3 months, P < .001 at 6, 9, 12, and 15 months. B, Between-group level of significance: P = .49 at time 0, P = .17 at 3 months, P < .001 at 6, 9, 12, and 15 months.

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