Role of lifestyle and risk factor modification clinic in patients with atrial fibrillation: a systematic review and meta-analysis of randomised controlled trials
Y Zhao, F J Ha, A J Brown, N NerlekarAbstract
Introduction
Incidence and recurrence of atrial fibrillation (AF) is associated with several lifestyle risk factors (1-5). Lifestyle and risk factor modification (LRFM) clinics could have a role in comprehensively addressing AF in a holistic patient-centred approach to improve clinical outcomes (6-7).
Purpose
We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) evaluating the role of LRFM clinics compared with usual care (UC) in the management of AF in general and in the context of catheter ablation for AF.
Methods
Online searches were conducted on electronic databases including PubMed, Scopus, Embase and ClinicalTrials.gov. Primary endpoint was AF recurrence. Secondary endpoints were total hospitalisations, AF-related hospitalisations, heart failure (HF) related hospitalisations, cardiovascular (CV) deaths, stroke or transient ischaemic attacks (TIA), and quality-of-life components.
Results
A total of 11 RCTs with a total of 3364 patients met the inclusion criteria (5 RCTs performed in the context of AF ablation). There were 1682 in the LRFM group and 1682 in the UC group. Mean age was 58-73, and 30% were female. 610 patients had persistent AF. Duration of follow-up ranged from 3 – 24 months. LRFM clinics significantly reduced the primary endpoint of AF recurrence compared with UC after catheter ablation (OR 0.34, 95% CI 0.23 - 0.51, p < 0.001) (Figure 1). LRFM clinics also reduced overall hospitalisations (OR 0.73, 95% CI 0.59 – 0.90, p = 0.003), AF-related hospitalisations (OR 0.74, 95% CI 0.58 – 0.93, p = 0.01) (Figure 2), and improved quality-of-life measures (mean improvement on Short Form 36 Questionnaire score 8.80, 95% CI 7.90 – 9.69, p < 0.001). There was no difference between LRFM and UC groups for CV deaths (OR 0.71, 95% CI 0.19 – 2.63, p = 0.61), stroke/TIA (OR 0.96, 95% CI 0.51 – 1.79, p = 0.89), or HF-related hospitalisations (OR 0.71, 95% CI 0.45 – 1.12, p = 0.14).
Conclusion
In this meta-analysis of RCTs, LRFM clinics reduced AF recurrence after catheter ablation, reduced total and AF-related hospitalisations, and improved quality of life. This analysis supports a multidisciplinary and lifestyle risk modification model of care to improve clinical outcomes in patients with AF.Figure 1Figure 2