Cardiac rehabilitation designed for obese patients with atrial fibrillation: OPTICARE XL results on burden, frequency and severity of Atrial Fibrillation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial Fibrillation (AF) is associated with substantial morbidity, mortality and low quality of life. Obesity is an important risk factor for AF and weight reduction is associated with a decrease in AF burden. Previous studies showed that conventional CR programs lead to insufficient weight reduction in obese patients. The OPTImal CArdiac REhabilitation XL (OPTICARE XL) study was an open label randomized controlled trial (RCT), evaluating effects of a CR program specifically designed for weight reduction in patients with obesity and non-valvular AF. Objective We hypothesize that this novel tailor-made CR program (OPTICARE XL) will lead to reduced AF burden, as compared to conventional CR. Design and setting: Multi-center RCT, conducted between February 2017 and January 2019 in 2 large Dutch CR centers. Patients were randomized to the OPTICARE XL CR intervention-program or a conventional CR-program. Methods The primary endpoint was AF symptom burden, assessed by the Atrial Fibrillation Severity Scale (AFSS). Secondary endpoints were AF symptom number, AF symptom frequency and AF symptom severity. Data were collected at baseline (prior to CR, T0), at the end of the intervention and conventional program (T1) and 1.5 year after inclusion (T2). Results Of 68 included patients, 28 were randomized to conventional CR and 40 to OPTICARE XL CR. Patients were predominantly male (60%), had a mean age of 62.4 ± 10.4 years and a mean BMI of 36.1 ± 4.4 kg/m2. With regards to AF burden, no significant within and between-group differences were observed between T0 and T1, T1 and T2, and T0 and T2 (OPTICARE XL: T0 14.6 ± 4.4, T1 14.1 ± 5.9, T2 14.3 ± 6.9; conventional CR: T0 16.4 ± 6.5, T1 15.3 ± 6.3, T2 15.9 ± 7.6; Figure 1). There was a significant difference (p=0.02) in the AF symptom number at T2 in favor of the intervention group (Figure 2). AF symptom frequency decreased in the intervention group from T0 to T2 (31.5 to 25.8; p=0.027) and in conventional CR from T0 to T1 (32.2 to 28.2; p=0.010). However, for both AF symptom frequency and symptom severity, no significant between-group differences were observed. Conclusion Compared to conventional CR, OPTICARE XL CR did not result in a reduced AF burden. However, it did reduce the AF symptom number at long-term follow-up. Novel CR programs such as OPTICARE XL may have added value in the treatment of obese patients with AF.