AHA: Lifestyle modification key to management of AF
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Addressing modifiable risks through lifestyle management is crucial for primary and secondary prevention of atrial fibrillation, according to a scientific statement from the American Heart Association.
AF risk factors such as obesity, diabetes, physical inactivity, sleep apnea, hypertension and other modifiable lifestyle-related factors such as smoking, alcohol use and hyperlipidemia are driving the increased incidence and prevalence of AF, but the trend is reversible, Mina K. Chung, MD, FAHA, FHRS, staff cardiologist in the section of pacing and electrophysiology in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, and chair of the writing group, and colleagues wrote.
“While established medical treatment protocols remain essential, helping AF patients adopt healthier lifestyle habits whenever possible may further help to reduce episodes of AF,” Chung said in a press release.
All health care providers should promote lifestyle modification in patients with AF or at risk for it, Chung and colleagues wrote.
Reasonable initial goals include weight loss of 10%, increase in physical activity by 2 metabolic equivalents of task (METs) per week, promotion of continuous positive airway pressure use in those with sleep apnea and managing tobacco and alcohol use as chronic diseases, according to the authors.
“To help patients make healthy lifestyle changes, we suggest setting specific, progressive achievable weight and exercise targets and prescribing lifestyle intervention programs that can provide appropriate supports,” Chung said in the release. “Using a pedometer, smartphone/watch apps or other wearable devices that provide activity feedback, as well as apps that help people track food intake, can be helpful to keep people motivated. Encouragement and reinforcement from the patients’ physicians and health care team can also increase patients’ dedication.”
To ensure all risk factors are addressed, referral to multidisciplinary teams and use of structured, comprehensive lifestyle counseling programs should be encouraged, Chung and colleagues wrote.
Most findings in this area are based on observational studies, so more research is needed, according to the authors.
“We need more research in this area, including randomized trials (which can prove cause and effect) to help determine the effects of and the best ways to achieve long-term, lifestyle and risk factor modification for our patients with AF,” Chung said in the release. “In particular, we need further work on the effects of high-intensity and other physical activities, and studies on the need for and effects of screening and treating sleep apnea for AF. However, the data emerging support the beneficial effects of lifestyle modification to reduce AF and are a call to action to develop and utilize integrated, multidisciplinary teams and/or structured programs that can facilitate intensive and comprehensive lifestyle counseling for our patients with AF. We encourage health care teams to consider lifestyle interventions in addition to medical management for all patients with AF.” – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.
Perspective
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John D. Day, MD, FACC, FHRS
The biggest take-home message is that the literature shows that at least half of patients can put their AF into remission with lifestyle optimization, and this AHA scientific statement lays out the data and the pathway to accomplish this. The beauty of lifestyle optimization for AF is that in the motivated patient, you can achieve long-term success rates every bit as good as antiarrhythmics and ablation, but without all of the side effects. Indeed, the only side effects of lifestyle optimization are good ones.
Lifestyle optimization of managing modifiable AF risk factors can be challenging in our modern society. At a minimum, physicians should at least give some medical advice on this subject, which is something any healthcare provider can do. For example, clinician counseling has been shown to improve smoking cessation by 66%. In addition to talking with patients about lifestyle optimization strategies, health care providers should at least help patients with AF get the resources they need to make these difficult changes like meeting with a dietician, cardiac rehab, working with a sleep clinic to treat sleep apnea, etc.
There still is so much to learn about modifiable risk factors for AF. Probably the biggest gap is with diet. Which diet is best to prevent or reverse AF? Which foods prevent or promote further AF episodes? What is the role, if any, of dietary supplements to prevent AF?
Overall, this is a much-needed scientific statement from the AHA. Lifestyle optimization strategies for AF management should be the initial treatment strategy for people presenting with new-onset AF. I fully applaud the writers of this scientific statement and the AHA for taking the leadership on this critically important topic.
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