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Top Things to Know:
Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation

  1. AF presents a large health threat and is associated with stroke, heart failure and death. It is projected that between 12.1 and 15.9 million people will be affected by atrial fibrillation (AF) in the US by 2050. The projected lifetime risk of developing AF in people >55 years is about 37%.
  2. Several risk factors associated with AF may be reversible. These include obesity, low physical activity, sleep apnea, hypertension, diabetes mellitus (DM), heart failure (HF) and alcohol or tobacco use.
  3. Studies have reported a positive impact on decreasing AF with lifestyle changes that focus on weight loss and increased physical activity, and risk factor modification.
  4. New paradigms are emerging for AF management, which include four pillars: lifestyle and risk factor management, anti-coagulation, rate control, and rhythm control. Lifestyle and risk factor management is the newest of these pillars.
  5. Obesity is a strong risk factor and is associated with incident and persistent AF. Data suggest that in obese or overweight patients, a 10% reduction in weight may reduce AF burden.
  6. Increased moderate physical activity may aid in reduction of AF and aligns with advice for good general cardiovascular health.
  7. Persons with AF have a higher prevalence of sleep disordered breathing (SDB) and sleep apnea. Treatment of SDB may decrease AF burden.
  8. DM is associated with a higher risk of AF and may predispose a patient to structural, electric and autonomic changes. Blood sugar control has been associated with reduced risk of AF and may be an important strategy to reduce recurrence of AF burden and should follow current guidelines.
  9. Hypertension is associated with risk of developing AF. Blood pressure management for AF follows current guidelines, and importantly includes both lifestyle (obesity, physical inactivity and diet) and pharmacotherapy.
  10. An integrated, multidisciplinary healthcare approach to management of AF that incorporates lifestyle interventions and aggressive risk factor modification with medical and ablative therapies may be most effective in reducing AF burden.

Citation

Chung MK, Eckhardt LL, Chen LY, Ahmed HM, Gopinathannair R, Joglar JA, Noseworthy PA, Pack QR, Sanders P, Trulock KM, on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee and Exercise, Cardiac Rehabilitation, and Secondary Prevention Committee of the Council on Clinical Cardiology, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular and Stroke Nursing, and Council on Lifestyle and Cardiometabolic Health. Lifestyle and risk factor modification for reduction of atrial fibrillation: a scientific statement from the American Heart Association [published online ahead of print March 9, 2020]. Circulation. doi: 10.1161/CIR.0000000000000748.