Adherence and Feasibility of a Multidisciplinary Lifestyle program for Patients with Atrial Fibrillation and Obesity (Preprint)

BACKGROUND Atrial Fibrillation (AF) is commonly associated with obesity. Observational studies showed that weight loss and improvement of physical fitness are associated with improved prognosis and a decrease in AF symptoms. However, despite these benefits, non-adherence is common. OBJECTIVE In this study we evaluated the adherence and feasibility of a multidisciplinary lifestyle program focusing on behavioural change in patients with AF and obesity. METHODS Patients with AF and obesity received a goal-oriented CR program for three months including 4 fixed modules: lifestyle counselling by an Advanced Nurse Practitioner, exercise training, dietary consultation and psychosocial therapy; relaxation sessions were an additional optional treatment module. After this CR program the Advanced Nurse Practitioner monitored the personal lifestyle of each individual patient 3 and 9 months of discharge CR. The primary endpoints were compliance and completion rates of the CR program, the latter being defined as performing at least of 80 % of the prescribed sessions. In addition, we performed an exploratory analysis of effects on weight and AF burden and frequency. RESULTS Ten patients with AF and obesity were recruited. The majority of patients were male (8/2), the mean age was 57.2 ± 9.0 and the BMI 32.4 ± 3.5 kg / m2. Eight patients completed the 3-months CR program. Two patients did not complete their CR program, both because of private issues. Adherence to the fixed treatment modules was 95% for lifestyle counselling, 86% for physiotherapy sessions, 88% for dietician consultations and 60% received psychosocial therapy; concerning the optional additional modules, 70% of patients were referred to the relaxation sessions and the adherence was 86%. Both weight and physical condition were improved. Frequency of AF-related symptoms was considerably reduced immediately after rehabilitation and was even lower after 1 year. Severity of AF complaints post-CR was similar to the baseline, but significantly lower after 1 year. CONCLUSIONS A one-year multidisciplinary lifestyle program was feasible in obese patients with AF with high compliance and completion rates. An exploratory analysis revealed a sustained reduction in AF symptoms, however, these results remain to be confirmed in larger studies. CLINICALTRIAL The study protocol was submitted for approval to Medical Research Ethics Committee of Máxima Medical Center (Veldhoven, the Netherlands) which confirmed that the Dutch Medical Research Involving Human Subjects Act does not apply to this study and therefore waived formal approval.