Obesity is known risk factor for atrial fibrillation (AF). However, the effect of weight reduction on AF symptom burden is unknown. In this study, 150 patients with symptomatic AF who were overweight or obese were randomized to a physician led weight loss program (intervention arm) or self-directed general lifestyle measures (control arm). All patients received intensive cardiometabolic risk factor management and were evaluated at 3 monthly intervals by blinded study personnel. Primary outcomes of interest were AF symptom burden and symptom severity evaluated using a validated tool to assess disease specific patient-reported health status. Secondary outcomes included holter-derived episodes of AF, left ventricular thickness and left atrial size on echocardiograms.
Over a mean follow-up duration of 15 months, a significantly larger reduction in weight was noted in the intervention arm (14.3 kg vs 3.6 kg, p<.001). Both AF symptom burden and severity scores declined more in the intervention arm compared to the control arm. Furthermore, the probability of having 1 or more AF episodes in follow-up was lower in the intervention group (0.6 [95% CI 0.5-0.7] to 0.2 [95% CI 0.1-0.3]) compared to control group (0.6 [95% CI 0.5-0.7] to 0.5 [95% CI 0.4-0.6]). While loss to follow-up rate was high (44% in intervention and 48% in control arms), they were similar in both groups and sensitivity analyses accounting for this suggested that the primary findings were robust
Overall burden and severity of disease specific AF symptoms was reduced with a structured, intensive weight loss program. This appeared to correlate with measures of AF frequency and duration. The myriad benefits of weight loss now include management of AF.
Summarized by Steven M. Bradley and Supriya Shore
- Abed HS, Wittert GA, Leong DP, Shirazi MG, Bahrami B, Middeldorp ME, et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA 2013;310(19):2050-60.