AHA: Advice on Lifestyle, Risk Factor Modification to Cut A-fib Events

To optimize outcomes for patients with A-fib, clinicians should increasingly encourage patient weight loss, physical activity, and other lifestyle changes, according to a new scientific statement sponsored by the American Heart Association.

Physicians have long focused on prescribing anticoagulants or performing procedures to prevent A-fib and reduce blood clots, writing committee chair Mina Chung, MD (Cleveland Clinic, OH), told TCTMD. However, recent studies have suggested that lifestyle and risk factor modification could be an additional “target” to help improve outcomes even more.

“While established medical treatment protocols remain essential, helping AF patients adopt healthier lifestyle habits whenever possible may further help to reduce episodes of AF,” she said in a press release.

In the statement reviewing the available evidence, published online this week ahead of print in Circulation, Chung and colleagues write that weight loss and increased physical activity are two lifestyle changes that could have the largest impact for A-fib patients.

Additionally, they recommend that patients with sleep-disordered breathing, or sleep apnea, as well as diabetes, receive appropriate treatment to reduce the risk of A-fib events. Blood pressure control, smoking cessation, and reduced alcohol intake can also improve outcomes, the authors write.

“These findings suggest that a new paradigm for A-fib management should include a new pillar targeting lifestyle and risk factor modification and that public health initiatives and policy recommendations that target these areas might effectively reduce the incidence and burden of A-fib,” the authors write.

Multidisciplinary Care Approach

For clinicians treating patients with A-fib, an integrated care approach is best, they recommend. “The number of factors related to A-fib management increases its complexity and may result in suboptimal care if only some of the risk factors are addressed adequately,” Chung and colleagues write. “Use of or referral to multidisciplinary teams may facilitate intensive and comprehensive lifestyle counseling. If these programs are not available locally, health systems interested in reducing the burden of A-fib could invest in such treatment teams.”

To address the unanswered questions related to how clinicians can best advise patients on how to modify their lifestyle and risk factors, Chung said “we need more randomized trials and more work on how we can achieve lifestyle modification effectively and how we can form and best utilize these integrative multidisciplinary teams and structured programs. It also would be very helpful for these efforts to be reimbursed.”

Chung added that cardiac rehabilitation programs may currently be reimbursed for patients with cardiac events, “but to help encourage our patients to undergo lifestyle risk factor modification, helping to cover the cost of these programs [for A-fib patients] would be very helpful.”

Ultimately, Chung acknowledged that the recommendations put forth in the statement for A-fib patients are similar to those already published for cardiovascular disease in general. However, “with atrial fibrillation, we may want to be more aggressive with our targets and really try to achieve the weight loss and increase in fitness,” she said.