Meta-analysis of Effect of Modest (≥10%) Weight Loss in Management of Overweight and Obese Patients With Atrial Fibrillation

• Published in: The American journal of cardiology 2019-11, Vol.124 (10), p.1568-1574
• Main Authors: Aldaas, Omar M., Lupercio, Florentino, Han, Frederick T., Hoffmayer, Kurt S., Krummen, David, Ho, Gordon, Raissi, Farshad, Birgersdotter-Green, Ulrika, Feld, Gregory K., Hsu, Jonathan C.
• Format: Article
• Language: English
• Subjects: Atrial Fibrillation - epidemiology; Atrial Fibrillation - prevention & control; Audio frequencies; Bias; Body mass index; Body Weight; Body weight gain; Body weight loss; Cardiac arrhythmia; Cardiovascular disease; Comorbidity; Confidence intervals; Continuity (mathematics); Disease Management; Electrocardiography; Epidemics; Fibrillation; Global Health; Humans; Incidence; Literature reviews; Meta-analysis; Obesity; Obesity - epidemiology; Obesity - therapy; Overweight; Overweight - epidemiology; Overweight - therapy; Prevalence; Recurrence; Reduction; Risk analysis; Risk Assessment - methods; Risk Factors; Stroke; Systematic review; Weight control; Weight Loss
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2019.08.009

Obesity and atrial fibrillation (AF) are growing epidemics with significant overlap in co-morbidities. Multiple smaller studies have evaluated the effects of weight loss and risk factor modification on recurrence of AF, reduction in AF burden and improvement in AF symptom severity. The objective of this study was to determine if a modest weight loss of ≥10% of initial body weight is enough to improve outcomes in overweight or obese patients with established AF. We performed an extensive literature search and systematic review of studies that compared weight loss of ≥10% versus weight loss of less than 10% or weight gain and assessed outcomes including recurrence of AF as determined through a Holter monitor, AF burden and improvement in AF symptom severity. Risk ratio 95% confidence intervals (CI) were measured for dichotomous variables and mean difference (MD) 95% CI were measured for continuous variables, where MD >0 favors the group with ≥10% weight loss. Five studies with a total of 548 patients were included. Patients who lost ≥10% of their initial body weight experienced less recurrence of AF (risk ratio 0.29; 95% CI 0.19 to 0.44) and a larger reduction in reported event frequency (MD 1.74; 95% CI 0.70 to 2.79), episode duration (MD 2.14; 95% CI 0.04 to 4.23), global episode severity (MD 1.89; 95% CI 1.34 to 2.45), and symptom severity (MD 5.36; 95% CI 3.75 to 6.97). In conclusion, weight loss is associated with less risk of recurrent AF, reduction in AF burden, and improvement in AF symptom severity.