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Pearsons A, Hanson CL, Hendriks JM, Neubeck L. Understanding for whom, under what conditions, and how an integrated approach to atrial fibrillation service delivery works: a realist review. Eur J Cardiovasc Nurs 2024; 23:323-336. [PMID: 38165026 DOI: 10.1093/eurjcn/zvad093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 01/03/2024]
Abstract
AIMS To understand for whom, under what conditions, and how an integrated approach to atrial fibrillation (AF) service delivery works (or does not work). METHODS AND RESULTS A realist review of integrated approaches to AF service delivery for adult populations aged ≥18 years. An expert panel developed an initial programme theory, searched and screened literature from four databases until October 2022, extracted and synthesized data using realist techniques to create context-mechanism-outcome configurations for integrated approaches to AF service, and developed an integrated approach refined programme theory. A total of 5433 documents were screened and 39 included. The refined programme theory included five context-mechanism-outcome configurations for how clinical and system-wide outcomes are affected by the way integrated approaches to AF service delivery are designed and delivered. This review identifies core mechanisms underpinning the already known fundamental components of integrated care. This includes having a central coordinator responsible for service organization to provide continuity of care across primary and secondary care ensuring services are patient centred. Additionally, a fifth pillar, lifestyle and risk factor reduction, should be recognized within an AF care pathway. CONCLUSION It is evident from our provisional theory that numerous factors need to interlink and interact over time to generate a successfully integrated model of care in AF. Stakeholders should embrace this complexity and acknowledge that the learnings from this review are integral to shaping future service delivery in the face of an aging population and increased prevalence of AF.
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Affiliation(s)
- Alice Pearsons
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh EH11 4BN, UK
| | - Coral L Hanson
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh EH11 4BN, UK
| | - Jeroen M Hendriks
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Sturt Road, Bedford Park, SA 5001, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Port Road, Adelaide, SA 5001, Australia
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh EH11 4BN, UK
- Sydney Nursing School, Charles Perkins Centre, University of Sydney, Johns Hopkins Road, Sydney, NSW 2006, Australia
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2
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Dixit S. Editorial commentary: Clarifying the association between atrial fibrillation and coronary artery disease. Trends Cardiovasc Med 2024; 34:99-100. [PMID: 36403870 DOI: 10.1016/j.tcm.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Sanjay Dixit
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, 1 Convention Avenue 2(nd) floor-City Side, Philadelphia, PA 19104, USA.
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3
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Yu X, Xu J, Lei M. Does a nurse-led interventional program improve clinical outcomes in patients with atrial fibrillation? A meta-analysis. BMC Cardiovasc Disord 2024; 24:39. [PMID: 38212681 PMCID: PMC10785428 DOI: 10.1186/s12872-024-03707-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Being the most common type of arrhythmia, atrial fibrillation (AF) is progressively increasing with an annual rate of 5 million new cases. Recent guidelines highlight the importance of using collaborative multidisciplinary teams in order to improve outcomes during management of patients with AF. A nurse-led program including a nurse-directed education, counselling and intervention has shown to improve patients' outcomes in candidates with AF. In this analysis, we aimed to systematically compare the clinical outcomes observed in patients with AF who were assigned to a nurse-led interventional program versus a usual care group. METHODS EMBASE, MEDLINE, Http://www. CLINICALTRIALS gov , Web of Science; Google Scholar and Cochrane databases were the data sources. The clinical outcomes were considered as the endpoints in this study. This is a meta-analysis, and the statistical analysis was conducted by the RevMan software (version 5.4). Risk ratios (RR) with 95% confidence intervals (CI) were used to represent the data after statistical analysis. RESULTS Six studies with a total number 2916 participants were included whereby 1434 participants were assigned to a nurse-led intervention and 1482 participants were assigned to the usual care group. Our results showed that participants with AF who were assigned to the nurse-led interventional group had a significantly lower risk of composite endpoints (RR: 0.82, 95% CI: 0.70-0.96; P = 0.01), heart failure (RR: 0.66, 95% CI: 0.47-0.92; P = 0.02), atrial fibrillation (RR: 0.77, 95% CI: 0.63-0.94; P = 0.01) and re-admission (RR: 0.78, 95% CI: 0.62-0.99; P = 0.04). However, the risks of all-cause mortality (RR: 0.86, 95% CI: 0.68-1.09; P = 0.21), cardiac death (RR: 0.67, 95% CI: 0.33-1.39; P = 0.28), myocardial infarction (RR: 0.70, 95% CI: 0.35-1.42; P = 0.33), stroke (RR: 0.75, 95% CI: 0.44-1.26; P = 0.28), all bleeding events (RR: 1.11, 95% CI: 0.81-1.53; P = 0.51) and major bleeding events (RR: 0.91, 95% CI: 0.56-1.49; P = 0.71) were not significantly different. CONCLUSIONS The nurse-led interventional program significantly improved composite endpoints including heart failure and the recurrence of AF, resulting in a significantly lower admission rate compared to the usual care group. However, nurse-led interventional program did not affect mortality, stroke, myocardial infarction and bleeding events. Based on our current results, a nurse-led interventional programs apparently could be beneficial in patients with AF. Future larger trials would be able to confirm this hypothesis.
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Affiliation(s)
- Xingcai Yu
- Cardiac catheterization unit, Yantaishan Hospital, Yantai, Shandong, 264000, People's Republic of China
| | - Jun Xu
- Health Management Centre, Yantai Qishan Hospital, Yantai, Shandong, 264001, People's Republic of China
| | - Min Lei
- Department of Nursing, Shaanxi Rehabilitation Hospital, Xian, Shaanxi, 710065, People's Republic of China.
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Erlingsdottir HY, Ketilsdottir A, Hendriks JM, Ingadottir B. Disease-Related Knowledge and Need for Revision of Care for Patients with Atrial Fibrillation: A Cross Sectional Study. Patient Prefer Adherence 2023; 17:2621-2630. [PMID: 37900057 PMCID: PMC10612480 DOI: 10.2147/ppa.s428444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023] Open
Abstract
Purpose To evaluate the disease-related knowledge of outpatients with atrial fibrillation (AF), and the relationship with health literacy and other background variables. Patients and Methods In this cross-sectional survey study, conducted in Iceland, patients with AF scheduled for an electrical cardioversion or AF catheter ablation were recruited from a hospital outpatient clinic. They completed the validated Atrial Fibrillation Knowledge Scale (AFKS), a 11-item instrument (with possible score 0-10, 10 being the best knowledge) which evaluates knowledge pertaining to AF in general, AF symptom detection and AF treatment. Health literacy was assessed with the 16 item European Health Literacy Survey Questionnaire (HLS-EU-Q) and patients answered questions about their background. Data was analysed with parametric tests. Results In total, 185 participants completed the questionnaire (mean age 63 ±10), 77% were male, 74% with previous electrical cardioversion and 76% were on non-vitamin K antagonist oral anticoagulants (NOAC) medication. The mean score on the AFKS was 6.5 (±1.8). The best knowledge was concerning oral anticoagulation therapy (96% answered correctly) and the least knowledge was regarding responses to AF episodes (17% answered correctly). Patients with sufficient health literacy (52%) had better knowledge of AF (M 6.8 ±1.7 vs M 6.3 ±1.9, p = 0.05). Age, educational level, health literacy and AF pattern explained 22% of the variance in AF knowledge. Conclusion Patients with AF have inadequate knowledge of their condition, potentially as a result of insufficient health literacy. AF knowledge may be improved using integrated management where patients are actively involved in the care and health literacy is considered in the provided patient education.
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Affiliation(s)
- Helga Yr Erlingsdottir
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Cardio-Vascular and Cancer Center, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Audur Ketilsdottir
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Cardio-Vascular and Cancer Center, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Jeroen M Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Brynja Ingadottir
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Office of Chief Nursing Officer, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
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5
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Liu H, Brobbey A, Ejaredar M, Lorenzetti D, Sajobi T, Arena R, James MT, Wilton SB. Effect of Multifactorial Risk Factor Interventions on Atrial Fibrillation: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101572. [PMID: 36584724 DOI: 10.1016/j.cpcardiol.2022.101572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
Evidence supports the benefit of managing atrial fibrillation (AF) specific risk factors in secondary prevention of AF. However, a comprehensive summary of the effect of multifactorial risk factor interventions on outcomes of patients with AF over long-term is lacking. We searched MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL databases from inception to October 2021 for both randomized controlled trials (RCT) and observational studies comparing multifactorial risk factor interventions to usual care in patients with AF. Fifteen studies (10 RCT, 5 observational) with 3786 patients were included (mean age 63.8 years, 64.0% males). Follow-up ranged from 3 to 42 months. We found no significant effects of multifactorial risk factor interventions on AF recurrence [pooled relative risk (RR): 0.93, 95% CI: 0.74-1.16, P = 0.51, I2 = 54%], AF-related rehospitalization at 12 months (RR: 0.69, 95% CI: 0.43-1.11, P= 0.13, I2 = 0%), cardiovascular rehospitalization at 12 months (RR: 0.76, 95% CI: 0.53-1.09, P= 0.13, I2 = 53%), or AF-related adverse events at 12 and 15 months. However, multifactorial interventions were associated with reduced AF-related symptoms and improved health-related quality of life (HRQoL) at all studied time points. Current evidence does not support consistent associations between multifactorial risk factor interventions and AF recurrence after rhythm control therapy or AF-related or cardiovascular hospitalization in patients with AF. However, these interventions are associated with clinically relevant improvement in AF-related symptoms and HRQoL. Additional randomized studies are required to evaluate the impact of multifactorial risk factor interventions on patient-centered health outcomes.
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Affiliation(s)
- Hongwei Liu
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Anita Brobbey
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maede Ejaredar
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Diane Lorenzetti
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Health Sciences Library, University of Calgary, Calgary, AB, Canada
| | - Tolulope Sajobi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ross Arena
- TotalCardiology(TM) Research Network, Calgary, AB, Canada; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL
| | - Matthew T James
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen B Wilton
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; TotalCardiology(TM) Research Network, Calgary, AB, Canada
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Abstract
The global prevalence of atrial fibrillation (AF) has increased substantially over the past three decades and is currently approximately 60 million cases. Incident AF and its clinical consequences are largely the result of risk factors that can be modified by lifestyle changes. In this Review, we provide evidence that the lifetime risk of AF is modified not only by sex and race but also through the clinical risk factor and comorbidity burden of individual patients. We begin by summarizing the epidemiology of AF, focusing on non-modifiable and modifiable risk factors, as well as targets and strategies for the primary prevention of AF. Furthermore, we evaluate the role of modifiable risk factors in the secondary prevention of AF as well as the potential effects of risk factor interventions on the frequency and severity of subsequent AF episodes. We end the Review by proposing strategies that require evaluation as well as global policy changes that are needed for the prevention of incident AF and the management of recurrent episodes in patients already affected by AF.
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7
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Linz D, Verheule S, Isaacs A, Schotten U. Considerations for the Assessment of Substrates, Genetics and Risk Factors in Patients with Atrial Fibrillation. Arrhythm Electrophysiol Rev 2021; 10:132-139. [PMID: 34777816 PMCID: PMC8576487 DOI: 10.15420/aer.2020.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/16/2021] [Indexed: 12/25/2022] Open
Abstract
Successful translation of research focussing on atrial arrhythmogenic mechanisms has potential to provide a mechanism-tailored classification and to support personalised treatment approaches in patients with AF. The clinical uptake and clinical implementation of new diagnostic techniques and treatment strategies require translational research approaches on various levels. Diagnostic translation involves the development of clinical diagnostic tools. Additionally, multidisciplinary teams are required for collaborative translation to describe genetic mechanisms, molecular pathways, electrophysiological characteristics and concomitant risk factors. In this article, current approaches for AF substrate characterisation, analysis of genes potentially involved in AF and strategies for AF risk factor assessment are summarised. The authors discuss challenges and obstacles to clinical translation and implementation into clinical practice.
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Affiliation(s)
- Dominik Linz
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine and Life Sciences, Maastricht University and Maastricht University Medical Center+, Maastricht, the Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Sander Verheule
- Department of Physiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Aaron Isaacs
- Department of Physiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Ulrich Schotten
- Department of Physiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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8
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Eberly LA, Dixit S. Factors underlying improved mortality in patients with atrial fibrillation. Trends Cardiovasc Med 2020; 31:474-475. [PMID: 33221491 DOI: 10.1016/j.tcm.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Lauren A Eberly
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, United States; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA, United States
| | - Sanjay Dixit
- Division of Cardiovascular Medicine, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States.
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9
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Smietana J, Santangeli P. Long-standing Persistent Atrial Fibrillation Ablation: How do You Perform it? JOURNAL OF CARDIAC ARRHYTHMIAS 2020. [DOI: 10.24207/jca.v33i2.3399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Catheter ablation of long-standing persistent atrial fibrillation (LSPAF) presents unique challenges and the lack of large body of evidence surrounding management makes for disagreement and different approaches for treatment. Outlined is a case example that offers a comprehensive approach to ablation in patients with LSPAF that consists of risk factor management, an ablation strategy, a rigorous trigger protocol and follow-up rhythm monitoring. The case presented highlights management of this difficult population as best guided by current evidence and our experience. Ablation treatment and management strategies will continue to evolve with further randomized data and the advent of improved ablation technologies.
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Affiliation(s)
- Jeffrey Smietana
- Hospital of University of Pennsylvania – Cardiovascular Division – Electrophysiology Section – Philadelphia/Pennsylvania – United States of America
| | - Pasquale Santangeli
- Hospital of University of Pennsylvania – Cardiovascular Division – Electrophysiology Section – Philadelphia/Pennsylvania – United States of America
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10
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Yaeger A, Keenan BT, Cash NR, Parham T, Deo R, Frankel DS, Schaller RD, Santangeli P, Nazarian S, Supple GE, Arkles J, Kumareswaran R, Hyman MC, Riley MP, Garcia FC, Lin D, Epstein AE, Callans DJ, Mora JI, Amaro A, Schwab R, Pack A, Marchlinski FE, Dixit S. Impact of a nurse-led limited risk factor modification program on arrhythmia outcomes in patients with atrial fibrillation undergoing catheter ablation. J Cardiovasc Electrophysiol 2020; 31:423-431. [PMID: 31916273 DOI: 10.1111/jce.14336] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/03/2019] [Accepted: 12/16/2019] [Indexed: 11/26/2022]
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.
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Affiliation(s)
- Amaryah Yaeger
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brendan T Keenan
- Sleep Medicine Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nancy R Cash
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tara Parham
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rajat Deo
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert D Schaller
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pasquale Santangeli
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saman Nazarian
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Supple
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey Arkles
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ramanan Kumareswaran
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew C Hyman
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael P Riley
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fermin C Garcia
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Lin
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew E Epstein
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Callans
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jorge I Mora
- Sleep Medicine Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anastassia Amaro
- Endocrinology Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Richard Schwab
- Sleep Medicine Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Allan Pack
- Sleep Medicine Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sanjay Dixit
- Cardiovascular Division, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
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11
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Yaeger A, Cash NR, Parham T, Frankel DS, Deo R, Schaller RD, Santangeli P, Nazarian S, Supple GE, Arkles J, Riley MP, Garcia FC, Lin D, Epstein AE, Callans DJ, Marchlinski FE, Kolansky DM, Mora JI, Amaro A, Schwab R, Pack A, Dixit S. A Nurse-Led Limited Risk Factor Modification Program to Address Obesity and Obstructive Sleep Apnea in Atrial Fibrillation Patients. J Am Heart Assoc 2019; 7:e010414. [PMID: 30571593 PMCID: PMC6405543 DOI: 10.1161/jaha.118.010414] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Obesity and obstructive sleep apnea (OSA) are associated with atrial fibrillation (AF), yet these conditions remain inadequately treated. We report on the feasibility and efficacy of a nurse‐led risk factor modification program utilizing a pragmatic approach to address obesity and OSA in AF patients. Methods and Results AF patients with obesity (body mass index ≥30 kg/m2) and/or the need for OSA management (high risk per Berlin Questionnaire or untreated OSA) were voluntarily enrolled for risk factor modification, which comprised patient education, lifestyle modification, coordination with specialists, and longitudinal management. Weight loss and OSA treatment were monitored by monthly follow‐up calls and/or continuous positive airway pressure (CPAP) unit downloads. Quality of life and arrhythmia symptoms were assessed with the SF‐36 and AF Severity Scale at baseline and at 6 months. From November 1, 2016 to October 31, 2017, 252 patients (age 63±11 years; 71% male; 57% paroxysmal AF) were enrolled, 189 for obesity and 93 for OSA. Obese patients who enrolled lost significantly greater percent body weight than those who declined (3% versus 0.3%; P<0.05). Among 93 patients enrolled for OSA, 70 completed sleep studies, OSA was confirmed in 50, and the majority (76%) started CPAP therapy. All components of quality of life and arrhythmia symptoms improved significantly from baseline to 6 months among enrolled patients. Conclusions A nurse‐led risk factor modification program is a potentially sustainable and generalizable model that can improve weight loss and OSA in AF patients, translating into improved quality of life and arrhythmia symptoms.
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Affiliation(s)
- Amaryah Yaeger
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - Nancy R Cash
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - Tara Parham
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - David S Frankel
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - Rajat Deo
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - Robert D Schaller
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - Pasquale Santangeli
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - Saman Nazarian
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - Gregory E Supple
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - Jeffrey Arkles
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - Michael P Riley
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - Fermin C Garcia
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - David Lin
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - Andrew E Epstein
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - David J Callans
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - Francis E Marchlinski
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - Daniel M Kolansky
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
| | - Jorge I Mora
- 2 Division of Sleep Medicine Hospital of The University of Pennsylvania Philadelphia PA
| | - Anastassia Amaro
- 3 Division of Endocrinology Hospital of The University of Pennsylvania Philadelphia PA
| | - Richard Schwab
- 2 Division of Sleep Medicine Hospital of The University of Pennsylvania Philadelphia PA
| | - Allan Pack
- 2 Division of Sleep Medicine Hospital of The University of Pennsylvania Philadelphia PA
| | - Sanjay Dixit
- 1 Division of Cardiovascular Hospital of The University of Pennsylvania Philadelphia PA
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12
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Middeldorp ME, Ariyaratnam J, Lau D, Sanders P. Lifestyle modifications for treatment of atrial fibrillation. Heart 2019; 106:325-332. [DOI: 10.1136/heartjnl-2019-315327] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/03/2019] [Accepted: 10/22/2019] [Indexed: 11/04/2022] Open
Abstract
The management of atrial fibrillation (AF) has focused on anticoagulation, rhythm control and ventricular rate control. Recently, a fourth pillar of AF management has been incorporated recognising the importance of risk factor management (RFM). There are several risk factors that contribute to the development and progression of AF, these include traditional risk factors such as age, hypertension, heart failure, diabetes and valvular heart disease. However, increasingly it is recognised that obesity, sleep apnoea, hyperlipidaemia, smoking, alcohol, physical inactivity, genetics, aortic stiffness are associated with the development of AF. Importantly, several of these risk factors are modifiable. We have seen the evolution of RFM programmes which have demonstrated promising results. Indeed, the evidence is now so compelling that major clinical guidelines strongly advocate that aggressive treatment of these risk factors as a key component of AF management. Patients with AF who comprehensively managed their risk factors demonstrate greater reduction in symptoms, AF burden, more successful ablations and improved outcomes with greater AF freedom. In this article, we will review the evidence for the association between cardiac risk factors and AF and assess the burgeoning evidence for improved AF outcomes associated with aggressive cardiac RFM.
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Huntsinger ME, Doshi RN. Nurse-directed Preventative Management of Atrial Fibrillation: Is it Feasible? J Innov Card Rhythm Manag 2019; 10:3836-3838. [PMID: 32479571 PMCID: PMC7252798 DOI: 10.19102/icrm.2019.100904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Mary E Huntsinger
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rahul N Doshi
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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