Tenbult Nicole, Kraal Jos, Brouwers Rutger, Spee Ruud, Eijsbouts Sabine, Kemps Hareld
Telemedicine and Rehabilitation in Chronic Disease, Flow, Center for Prevention, Máxima MC, Veldhoven/Eindhoven, Netherlands.
Faculty Industrial Design Engineering, Delft, Netherlands.
JMIR Form Res. 2022 Apr 29;6(4):e32625. doi: 10.2196/32625.
Atrial fibrillation is commonly associated with obesity. Observational studies have shown that weight loss is associated with improved prognosis and a decrease in atrial fibrillation frequency and severity. However, despite these benefits, nonadherence to lifestyle programs is common.
In this study, we evaluated adherence to and feasibility of a multidisciplinary lifestyle program focusing on behavior change in patients with atrial fibrillation and obesity.
Patients with atrial fibrillation and obesity participated in a 1-year goal-oriented cardiac rehabilitation program. After baseline assessment, the first 3 months included a cardiac rehabilitation intervention with 4 fixed modules: lifestyle counseling (with an advanced nurse practitioner), exercise training, dietary consultation, and psychosocial therapy; relaxation sessions were an additional optional treatment module. An advanced nurse practitioner monitored the personal lifestyle of each individual patient, with assessments and consultations at 3 months (ie, immediately after the intervention) and at the end of the year (ie, 9 months after the intervention). At each timepoint, level of physical activity, personal goals and progress, atrial fibrillation symptoms and frequency (Atrial Fibrillation Severity Scale), psychosocial stress (Generalized Anxiety Disorder-7), and depression (Patient Health Questionnaire-9) were assessed. The primary endpoints were adherence (defined as the number of visits attended as percentage of the number of planned visits) and completion rates of the cardiac rehabilitation intervention (defined as performing at least of 80% of the prescribed sessions). In addition, we performed an exploratory analysis of effects of the cardiac rehabilitation program on weight and atrial fibrillation symptom frequency and severity.
Patients with atrial fibrillation and obesity (male: n=8; female: n=2; age: mean 57.2 years, SD 9.0; baseline weight: mean 107.2 kg, SD 11.8; baseline BMI: mean 32.4 kg/m2, SD 3.5) were recruited. Of the 10 participants, 8 participants completed the 3-month cardiac rehabilitation intervention, and 2 participants did not complete the cardiac rehabilitation intervention (both because of personal issues). Adherence to the fixed treatment modules was 95% (mean 3.8 sessions attended out of mean 4 planned) for lifestyle counseling, 86% (mean 15.2 sessions attended out of mean 17.6 planned) for physiotherapy sessions, 88% (mean 3.7 sessions attended out of mean 4.1 planned) for dietician consultations, and 60% (mean 0.6 sessions attended out of mean 1.0 planned) for psychosocial therapy; 70% of participants (7/10) were referred to the optional relaxation sessions, for which adherence was 86% (mean 2 sessions attended out of mean 2.4 planned). The frequency of atrial fibrillation symptoms was reduced immediately after the intervention (before: mean 35.6, SD 3.8; after: mean 31.2, SD 3.3), and this was sustained at 12 months (mean 24.8, SD 3.2). The severity of atrial fibrillation complaints immediately after the intervention (mean 20.0, SD 3.7) and at 12 months (mean 9.3, SD 3.6) were comparable to that at baseline (mean 16.6, SD 3.3).
A 1-year multidisciplinary lifestyle program for obese patients with atrial fibrillation was found to be feasible, with high adherence and completion rates. Exploratory analysis revealed a sustained reduction in atrial fibrillation symptoms; however, these results remain to be confirmed in large-scale studies.
心房颤动通常与肥胖有关。观察性研究表明，体重减轻与预后改善以及心房颤动频率和严重程度降低有关。然而，尽管有这些益处，但不坚持生活方式计划的情况很常见。
在本研究中，我们评估了一项针对心房颤动和肥胖患者的以行为改变为重点的多学科生活方式计划的依从性和可行性。
心房颤动和肥胖患者参加了为期1年的目标导向性心脏康复计划。在基线评估后，前3个月包括心脏康复干预，有4个固定模块：生活方式咨询（由高级执业护士进行）、运动训练、饮食咨询和心理社会治疗；放松课程是一个额外的可选治疗模块。一名高级执业护士监测每位患者的个人生活方式，在3个月时（即干预结束后立即）和年底（即干预后9个月）进行评估和咨询。在每个时间点，评估身体活动水平、个人目标和进展、心房颤动症状和频率（心房颤动严重程度量表）、心理社会压力（广泛性焦虑症-7）和抑郁（患者健康问卷-9）。主要终点是依从性（定义为就诊次数占计划就诊次数的百分比）和心脏康复干预的完成率（定义为至少完成规定疗程的80%）。此外，我们对心脏康复计划对体重以及心房颤动症状频率和严重程度的影响进行了探索性分析。
招募了心房颤动和肥胖患者（男性：n = 8；女性：n = 2；年龄：平均57.2岁，标准差9.0；基线体重：平均107.2 kg，标准差11.8；基线BMI：平均32.4 kg/m²，标准差3.5）。10名参与者中，8名参与者完成了3个月的心脏康复干预，2名参与者未完成心脏康复干预（均因个人问题）。生活方式咨询的固定治疗模块依从率为95%（平均计划4次就诊，实际就诊3.8次），物理治疗课程为86%（平均计划17.6次就诊，实际就诊15.2次），营养师咨询为88%（平均计划4.1次就诊，实际就诊3.7次），心理社会治疗为60%（平均计划1.0次就诊，实际就诊0.6次）；70%的参与者（7/10）被转介到可选的放松课程，其依从率为86%（平均计划2.4次就诊，实际就诊2次）。干预后心房颤动症状频率立即降低（干预前：平均35.6，标准差3.8；干预后：平均31.2，标准差3.3），并在12个月时持续（平均24.8，标准差3.2）。干预后立即（平均20.0，标准差3.7）和12个月时（平均9.3，标准差3.6）心房颤动主诉的严重程度与基线时（平均16.6，标准差3.3）相当。
一项针对肥胖心房颤动患者的为期1年的多学科生活方式计划被发现是可行的，具有高依从率和完成率。探索性分析显示心房颤动症状持续减少；然而，这些结果仍有待在大规模研究中得到证实。
