Objective: Weight loss (WL) can improve arrhythmia outcomes in obese patients (pts) with atrial fibrillation (AF). Although WL in this population has been achieved by strict dietary and lifestyle modification in physician-led research protocols, these resource intensive strategies have limited real-life applicability. We report the efficacy of a pragmatic outpatient based nurse-led risk factor modification (RFM) program that utilizes a high-touch, single point of care approach for achieving WL in AF pts at a tertiary care arrhythmia program.
Methods: All new AF pts with obesity (defined as body mass index (BMI) ≥30kg/m2) were offered enrollment. The pragmatic approach to WL focused on patient engagement and education, motivational interviewing, development of individualized lifestyle modification goals to improve dietary and exercise habits, and longitudinal telephonic care management to reinforce these changes. WL and compliance with established goals were assessed during ongoing biweekly (initial 2 months) then monthly follow-up support calls for up to 12 months. Continuing participation in RFM program was on a voluntary basis. Pts unable to achieve ≥3% WL by 3 months were referred for escalated care to a WL physician specialist. Pts who declined participation served as controls. Student t-test and chi-square tests were used to compare continuous and dichotomous variables.
Results: Between 11/1/16 to 10/31/17, 189 pts (BMI 36.3±6) enrolled in RFM program, and 115 pts (BMI 35.5±5.4; P=NS) declined participation. The majority of enrolled pts (72%, n=136 of 189) had failed ≥1 previous WL attempts. Follow-up WL data (5.5±4.1 months for enrolled; 5.2±2.9 months for declined; P=NS) was available and compared in 162 enrolled (86%, n=162 of 189) and 59 declined (51%, n=59 of 115) pts. Pts enrolled in RFM program achieved significantly greater WL than declined pts (2.7±3.8% vs. 0.3±3.5%, respectively; p<0.05). See table for details.
Conclusions: A pragmatic nurse-led risk factor modification strategy focusing on lifestyle changes reinforced by frequent patient follow-up can be effective in achieving weight loss in obese atrial fibrillation patients. This single point of care approach is a potentially sustainable model for maintaining weight loss in this population.