Heart, Lung and Circulation

Risk Reduction Interventions in Atrial Fibrillation: A Systematic Review

      Background: Approximately 240,000 Australians live with atrial fibrillation (AF), many having multiple cardiovascular risk factors and high stroke risk, but most are not included in structured risk reduction programs. We aimed to determine if risk reduction programs can improve physical activity levels, quality of life (QoL) or cardiovascular risk in AF sufferers.
      Methods: We conducted a systematic review of clinical trials evaluating lifestyle and biomedical risk reduction interventions in AF patients. Trials were identified by searching electronic databases, reference lists and grey literature. Trials were included if conducted by a health professional, and changes in multiple risk factor levels or QoL were reported.
      Results: Five trials were identified (166 participants): two randomised controlled trials, one comparative cohort and two pre-post designs. Exercise capacity improved at follow-up (2–12 months) in the intervention group in all trials. Two measured VO2max (2.5–5.4 ml/kg/min (17–32%) improvement, p < 0.02); one measured six minute walking distance (114 m (27%) improvement, p < 0.001); one measured cumulated work (564 W/min (37%) improvement, p < 0.001) and one utilised incremental exercise testing (11 m/min (10%) improvement, p = 0.05). Three trials evaluated heart rate (HR), identifying resting HR reduction of 7–13 bpm (p < 0.05) and two identified HR reduction during exertion of 9 bpm (p < 0.05). Two trials measured QoL, both reporting significant improvements in SF-36 physical summary scores.
      Conclusions: Literature suggests risk reduction interventions for AF can improve exercise capacity, QoL and reduce HR, however the evidence base is small, methodologically compromised and only evaluates exercise therapy. High quality research in this area is required to help the numerous Australians living with AF.