Lifestyle risk reduction interventions in atrial fibrillation: a systematic review

Background: The burden of atrial fibrillation (AF) is escalating even though it is potentially modifiable. Affected persons, at high risk of stroke and death, are typically not targeted for risk reduction. We aimed to determine if risk-factor interventions can improve physical functioning, health-related quality of life (HRQoL) and cardiovascular risk in AF.

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 reported changes in multiple risk factor levels or HRQoL.

Results: Five trials, solely exercise based, were identified (166 participants): two randomised controlled trials, one quasi-experimental and two pre-post designs. Exercise capacity improved after 2–12 months in the intervention group in all trials. This was assessed by maximal oxygen uptake (two trials, 2.5–5.4 ml/kg/min (17–32%) improvement, p < 0.02); six-minute walking distance (one trial, 114 m (27%) improvement, p < 0.001); cumulated work (one trial, 564 W/min (37%) improvement, p < 0.001) and incremental exercise testing (one trial, 11 m/min (10%) improvement, p = 0.05). Three trials evaluated heart rate (HR), demonstrating HR reduction at rest (7–13 bpm, p < 0.05) and during exercise (9 bpm, p < 0.05). Two trials measured HRQoL, both reporting significant improvements in SF-36 physical summary scores.

Conclusions: Literature suggests risk reduction interventions for AF can improve exercise levels, HRQoL and reduce HR, but the evidence base is small, methodologically compromised and focused on physical functioning. High-quality research in this area is required in order to help the multitudes of people living with AF.