Role of Lifestyle and Risk Factor Modification Clinics in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Abstract
Background
Incidence and recurrence of atrial fibrillation (AF) are associated with several lifestyle risk factors. Lifestyle and risk factor modification (LRFM) clinics could have a role in comprehensively addressing AF from a holistic, patient-centered approach to improve clinical outcomes.
Methods
We performed a systematic review and meta-analysis of randomized controlled trials evaluating the role of LRFM clinics compared with usual care in patients with AF. The primary end point was atrial arrhythmia recurrence. Secondary end points were AF and heart failure-related hospitalization, cardiovascular death, stroke or transient ischemic attack, and quality-of-life.
Results
Eleven randomized controlled trials with a total of 3364 patients were included (5 randomized controlled trials performed in the context of AF ablation). Mean age was 58 to 73 years, 30% were female, and 18% had persistent AF. Duration of follow-up ranged from 3 to 24 months. LRFM clinics significantly reduced the primary end point of arrhythmia recurrence compared with usual care after catheter ablation (odds ratio, 0.34 [95% CI, 0.23-0.51]; P<0.001, I2=0%). LRFM clinics also reduced AF-related hospitalization (odds ratio, 0.70 [95% CI, 0.51-0.98]; P=0.04, I2=21%) and improved quality-of-life (mean improvement on Short Form 36 Questionnaire, 8.90 [95% CI, 6.91-10.90]; P<0.001). There was no detected difference between LRFM clinics and usual care for heart failure-related hospitalization (P=0.16), cardiovascular deaths (P=0.79), or stroke/transient ischemic attack (P=0.83).
Conclusions
In this meta-analysis of randomized controlled trials, LRFM clinics reduced AF recurrence after ablation, reduced AF-related hospitalization, and improved quality of life. This study supports a comprehensive multidisciplinary lifestyle risk modification model of care to improve clinical outcomes in patients with AF.