Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study (LEGACY)

Rajeev K Pathak; Melissa E Middeldorp; Megan Meredith; Abhinav B Mehta; Rajiv Mahajan; Christopher X Wong; Darragh Twomey; Adrian D Elliott; Jonathan M Kalman; Walter P Abhayaratna; Dennis H Lau; Prashanthan Sanders

doi:10.1016/j.jacc.2015.03.002

Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study (LEGACY)

J Am Coll Cardiol. 2015 May 26;65(20):2159-69. doi: 10.1016/j.jacc.2015.03.002. Epub 2015 Mar 16.

Affiliations

¹ Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
² Research School of Finance, Actuarial Studies and Applied Statistics, Australian National University, Canberra, Australia.
³ Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom.
⁴ Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; School of Medical Sciences, University of Adelaide, Adelaide, Australia.
⁵ Department of Cardiology, Royal Melbourne Hospital and the Department of Medicine, University of Melbourne, Melbourne, Australia.
⁶ College of Medicine, Biology and Environment, Australian National University and Canberra Hospital, Canberra, Australia.
⁷ Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia. Electronic address: prash.sanders@adelaide.edu.au.

PMID: 25792361
DOI: 10.1016/j.jacc.2015.03.002

Abstract

Background: Obesity and atrial fibrillation (AF) frequently coexist. Weight loss reduces the burden of AF, but whether this is sustained, has a dose effect, or is influenced by weight fluctuation is unknown.

Objectives: This study sought to evaluate the long-term impact of weight loss and weight fluctuation on rhythm control in obese individuals with AF.

Methods: Of 1,415 consecutive patients with AF, 825 had a body mass index ≥ 27 kg/m(2) and were offered weight management. After screening for exclusion criteria, 355 were included in this analysis. Weight loss was categorized as group 1 (≥ 10%), group 2 (3% to 9%), and group 3 (<3%). Weight trend and/or fluctuation was determined by yearly follow-up. We determined the impact on the AF severity scale and 7-day ambulatory monitoring.

Results: There were no differences in baseline characteristics or follow-up among the groups. AF burden and symptom severity decreased more in group 1 compared with groups 2 and 3 (p < 0.001 for all). Arrhythmia-free survival with and without rhythm control strategies was greatest in group 1 compared with groups 2 and 3 (p < 0.001 for both). In multivariate analyses, weight loss and weight fluctuation were independent predictors of outcomes (p < 0.001 for both). Weight loss ≥ 10% resulted in a 6-fold (95% confidence interval: 3.4 to 10.3; p < 0.001) greater probability of arrhythmia-free survival compared with the other 2 groups. Weight fluctuation >5% partially offset this benefit, with a 2-fold (95% confidence interval: 1.0 to 4.3; p = 0.02) increased risk of arrhythmia recurrence.

Conclusions: Long-term sustained weight loss is associated with significant reduction of AF burden and maintenance of sinus rhythm. (Long-Term Effect of Goal directed weight management on Atrial Fibrillation Cohort: A 5 Year follow-up study [LEGACY Study]; ACTRN12614001123639).

Keywords: ablation; atrial fibrillation; cardiac risk factors; obesity; outcomes; remodeling.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Atrial Fibrillation / complications*
Female
Follow-Up Studies
Goals
Humans
Male
Middle Aged
Obesity / complications*
Obesity / therapy*
Severity of Illness Index
Time
Time Factors
Weight Loss*

Associated data

ANZCTR/ACTRN12614001123639