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

Abstract

BACKGROUND:

We have previously demonstrated the feasibility of a nurse-led risk factor modification (RFM) program for improving weight loss and obstructive sleep apnea (OSA) care among patients with atrial fibrillation (AF).

OBJECTIVE:

We now report its impact on arrhythmia outcomes in a subgroup of patients undergoing catheter ablation.

METHODS:

Participating patients with obesity and/or need for OSA management (high risk per Berlin Questionnaire or untreated OSA) underwent in-person consultation and monthly telephone calls with the nurse for up to 1 year. Arrhythmias were assessed by office ECGs and ≥2 wearable monitors. Outcomes, defined as Arrhythmia control (0-6 self-terminating recurrences, with ≤1 cardioversion for nonparoxysmal AF) and Freedom from arrhythmias (no recurrences on or off antiarrhythmic drugs), were compared at 1 year between patients undergoing catheter ablation who enrolled and declined RFM.

RESULTS:

Between 1 November 2016 and 1 April 2018, 195 patients enrolled and 196 declined RFM (body mass index, 35.1 ± 6.7 vs 34.3 ± 6.3 kg/m2 ; 50% vs 50% paroxysmal AF; P = NS). At 1 year, enrolled patients demonstrated significant weight loss (4.7% ± 5.3% vs 0.3% ± 4.4% in declined patients; P < .0001) and improved OSA care (78% [n = 43] of patients diagnosed with OSA began treatment). However, outcomes were similar between enrolled and declined patients undergoing ablation (arrhythmia control in 80% [n = 48] vs 79% [n = 38]; freedom from arrhythmia in 58% [n = 35] vs 71% [n = 34]; P = NS).

CONCLUSION:

Despite improving weight loss and OSA care, our nurse-led RFM program did not impact 1-year arrhythmia outcomes in patients with AF undergoing catheter ablation.

• Authors: Amaryah Yaeger, Brendan T Keenan, Nancy R Cash, Tara Parham, Rajat Deo, David S Frankel, Robert D Schaller, Pasquale Santangeli, Saman Nazarian, Gregory E Supple, Jeffrey Arkles, Ramanan Kumareswaran, Matthew C Hyman, Michael P Riley, Fermin C Garcia, David Lin, Andrew E Epstein, David J Callans, Jorge I Mora, Anastassia Amaro, Richard Schwab, Allan Pack, Francis E Marchlinski, Sanjay Dixit
• Journal: Journal of cardiovascular electrophysiology (J Cardiovasc Electrophysiol) Vol. 31 Issue 2 Pg. 423-431 (02 2020) ISSN: 1540-8167 [Electronic] United States
• PMID: 31916273 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 Wiley Periodicals, Inc.

Chemical References

• Anti-Arrhythmia Agents

Topics

• Aged
• Anti-Arrhythmia Agents
• Atrial Fibrillation (diagnosis, physiopathology, surgery)
• Body Mass Index
• Catheter Ablation (adverse effects)
• Diet, Healthy (nursing)
• Exercise
• Female
• Health Status
• Humans
• Male
• Middle Aged
• Nurse's Role
• Obesity (diagnosis, nursing, physiopathology)
• Patient Education as Topic
• Program Evaluation
• Recurrence
• Risk Factors
• Risk Reduction Behavior
• Sleep
• Sleep Apnea, Obstructive (diagnosis, nursing, physiopathology)
• Time Factors
• Treatment Outcome
• Weight Loss