Impact of a nurse‐led limited risk factor modification program on arrhythmia outcomes in patients with atrial fibrillation undergoing catheter ablation
Amaryah Yaeger, Brendan T Keenan, Nancy R. Cash, Tara Parham, Rajat Deo, David S. Frankel, Robert D. Schaller, Pasquale Santangeli, Saman Nazarian, Gregory E. Supple, Jeffrey Arkles, Ramanan Kumareswaran, Matthew C. Hyman, Michael P. Riley, Fermin C. García, David Lin, Andrew E. Epstein, David J. Callans, Jorge Mora, Anastassia Amaro, Richard J. Schwab, Allan I Pack, Francis E. Marchlinski, Sanjay Dixit
Abstract
BACKGROUND: We have previously demonstrated the feasibility of a nurse-led risk factor modification (RFM) program for improving weight loss and obstructive sleep apnea (OSA) care among patients with atrial fibrillation (AF). OBJECTIVE: We now report its impact on arrhythmia outcomes in a subgroup of patients undergoing catheter ablation. METHODS: Participating patients with obesity and/or need for OSA management (high risk per Berlin Questionnaire or untreated OSA) underwent in-person consultation and monthly telephone calls with the nurse for up to 1 year. Arrhythmias were assessed by office ECGs and ≥2 wearable monitors. Outcomes, defined as Arrhythmia control (0-6 self-terminating recurrences, with ≤1 cardioversion for nonparoxysmal AF) and Freedom from arrhythmias (no recurrences on or off antiarrhythmic drugs), were compared at 1 year between patients undergoing catheter ablation who enrolled and declined RFM. RESULTS: ; 50% vs 50% paroxysmal AF; P = NS). At 1 year, enrolled patients demonstrated significant weight loss (4.7% ± 5.3% vs 0.3% ± 4.4% in declined patients; P < .0001) and improved OSA care (78% [n = 43] of patients diagnosed with OSA began treatment). However, outcomes were similar between enrolled and declined patients undergoing ablation (arrhythmia control in 80% [n = 48] vs 79% [n = 38]; freedom from arrhythmia in 58% [n = 35] vs 71% [n = 34]; P = NS). CONCLUSION: Despite improving weight loss and OSA care, our nurse-led RFM program did not impact 1-year arrhythmia outcomes in patients with AF undergoing catheter ablation.