Circulation. 2020 Apr 21;141(16):e750-e772. doi: 10.1161/CIR.0000000000000748. Epub 2020 Mar 9.
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is associated with substantial morbidity, mortality, and healthcare use. Great strides have been made in stroke prevention and rhythm control strategies, yet reducing the incidence of AF has been slowed by the increasing incidence and prevalence of AF risk factors, including obesity, physical inactivity, sleep apnea, diabetes mellitus, hypertension, and other modifiable lifestyle-related factors. Fortunately, many of these AF drivers are potentially reversible, and emerging evidence supports that addressing these modifiable risks may be effective for primary and secondary AF prevention. A structured, protocol-driven multidisciplinary approach to integrate lifestyle and risk factor management as an integral part of AF management may help in the prevention and treatment of AF. However, this aspect of AF management is currently underrecognized, underused, and understudied. The purpose of this American Heart Association scientific statement is to review the association of modifiable risk factors with AF and the effects of risk factor intervention. Implementation strategies, care pathways, and educational links for achieving impactful weight reduction, increased physical activity, and risk factor modification are included. Implications for clinical practice, gaps in knowledge, and future directions for the research community are highlighted.
心房颤动(AF)是最常见的持续性心律失常,与大量的发病率、死亡率和医疗保健使用相关。在预防中风和节律控制策略方面已经取得了重大进展,但由于 AF 风险因素的发病率和患病率不断增加,包括肥胖、身体活动不足、睡眠呼吸暂停、糖尿病、高血压和其他可改变的生活方式相关因素,AF 的发病率降低速度放缓。幸运的是,许多这些 AF 驱动因素是潜在可逆转的,并且新出现的证据支持解决这些可改变的风险因素可能对原发性和继发性 AF 预防有效。一种结构化、协议驱动的多学科方法,将生活方式和危险因素管理整合为 AF 管理的一个组成部分,可能有助于预防和治疗 AF。然而,目前对 AF 管理的这一方面认识不足、使用率低且研究不足。本美国心脏协会科学声明的目的是审查可改变的危险因素与 AF 的关联,以及危险因素干预的效果。包括实现有影响力的体重减轻、增加身体活动和危险因素改变的实施策略、护理途径和教育联系。强调了对临床实践的影响、知识差距和研究界的未来方向。