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Effect of Weight Reduction and Cardiometabolic Risk Factor Management on Symptom Burden and Severity in Patients With Atrial Fibrillation: A Randomized Clinical Trial
Abstract
IMPORTANCE: Obesity is a risk factor for atrial fibrillation. Whether weight reduction and cardiometabolic risk factor management can reduce the burden of atrial fibrillation is not known. OBJECTIVE: To determine the effect of weight reduction and management of cardiometabolic risk factors on atrial fibrillation burden and cardiac structure. DESIGN, SETTING, AND PATIENTS: Single-center, partially blinded, randomized controlled study conducted between June 2010 and December 2011 in Adelaide, Australia, among overweight and obese ambulatory patients (N = 150) with symptomatic atrial fibrillation. Patients underwent a median of 15 months of follow-up. INTERVENTIONS: Patients were randomized to weight management (intervention) or general lifestyle advice (control). Both groups underwent intensive management of cardiometabolic risk factors. MAIN OUTCOMES AND MEASURES: The primary outcomes were Atrial Fibrillation Severity Scale scores: symptom burden and symptom severity. Scores were measured every 3 months from baseline to 15 months. Secondary outcomes performed at baseline and 12 months were total atrial fibrillation episodes and cumulative duration measured by 7-day Holter, echocardiographic left atrial area, and interventricular septal thickness. RESULTS: Of 248 patients screened, 150 were randomized (75 per group) and underwent follow-up. The intervention group showed a significantly greater reduction, compared with the control group, in weight (14.3 and 3.6 kg, respectively; P < .001) and in atrial fibrillation symptom burden scores (11.8 and 2.6 points, P < .001), symptom severity scores (8.4 and 1.7 points, P < .001), number of episodes (2.5 and no change, P = .01), and cumulative duration (692-minute decline and 419-minute increase, P = .002). Additionally, there was a reduction in interventricular septal thickness in the intervention and control groups (1.1 and 0.6 mm, P = .02) and left atrial area (3.5 and 1.9 cm2, P = .02). CONCLUSIONS AND RELEVANCE: In this study, weight reduction with intensive risk factor management resulted in a reduction in atrial fibrillation symptom burden and severity and in beneficial cardiac remodeling. These findings support therapy directed at weight and risk factors in the management of atrial fibrillation. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12610000497000.
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“Although there is ample evidence that weight loss and maintaining an ideal weight are beneficial in reducing AF burden and symptoms, compliance with this recommendation is poor; the reasons include among others the inability to track food intake (Abed 2013, Donnellan 2019, Pathak 2015).”
From 2021 ISHNE/HRS/EHRA/APHRS Expert Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society (2021) · cites this paper as Abed 2013
In the citing paper
“Intensive weight-reduction management in addition to management of other cardiovascular risk factors (in the range of 10-15 kg weight loss achieved) led to fewer AF recurrences and symptoms compared with an approach based on general advice in obese patients with AF.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [204]
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Patient Centered mobile Health TECHnology Enabled Atrial Fibrillation Management (mTECH Afib)
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Association between obesity and cardiac conduction defects
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2025 Thai guideline for the diagnosis and management of atrial fibrillation
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Irregular, narrow-complex tachycardia.
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2018 Korean Heart Rhythm Society Guidelines for Non-Vitamin K Antagonist Oral Anticoagulants
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Physical Activity and Incidence of Atrial Fibrillation - Systematic Review and Meta-Analysis
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Metadata
- Authors
- Abed, H. S., Wittert, G. A., Leong, D. P., Shirazi, M. G., Bahrami, B., Middeldorp, M. E., Lorimer, M. F., Lau, D. H., Antic, N. A., Brooks, A. G., Abhayaratna, W. P., Kalman, J. M., & Sanders, P.
- Affiliations
- Royal Adelaide Hospital (AU)
- The University of Adelaide (AU)
- Repatriation General Hospital (AU)
- Australian National University (AU)
- The Royal Melbourne Hospital (AU)
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2013-11-20
- Volume
- 310
- Issue
- 19
- Pages
- 2050
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W1963940525
- Cited by
- 776
- References
- 52
- Citations by year
- 2026: 51 · 2025: 64 · 2024: 69 · 2023: 53 · 2022: 56 · 2021: 76 · 2020: 50 · 2019: 70 · 2018: 52 · 2017: 81 · 2016: 63 · 2015: 51 · 2014: 35 · 2013: 4
- FWCI
- 34.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Flinders Academic Commons (Flinders University) (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Flinders Academic Commons (Flinders University) (submittedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- weight loss, obesity, cardiometabolic risk factors, symptom burden, symptom severity, cardiac remodeling, left atrial area, interventricular septum thickness, lifestyle intervention, overweight patients, Holter monitoring, cardiac structure, risk factor control, weight management, lifestyle advice
- MeSH terms
- Aged, Atrial Fibrillation, Diet, Reducing, Echocardiography, Fish Oils, Heart Atria, Humans, Life Style, Male, Middle Aged, Obesity, Risk Factors, Severity of Illness Index, Weight Loss, Treatment Outcome, Overweight
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