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Obesity: Past and Projected Rate

L ong-Term E ffect of G oal Directed Weight Management in an A trial Fibrillation C ohort: A 5 Follow -Up Stud Y (LEGACY STUDY). Rajeev K. Pathak; Melissa E. Middeldorp; Megan Meredith; Abhinav B. Mehta; Rajiv Mahajan; Walter P. Abhayaratna; Dennis H. Lau; Prashanthan Sanders.

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Obesity: Past and Projected Rate

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  1. Long-Term Effect of Goal Directed Weight Management in an Atrial Fibrillation Cohort: A 5 Follow-Up StudY (LEGACY STUDY) Rajeev K. Pathak; Melissa E. Middeldorp; Megan Meredith;Abhinav B. Mehta; Rajiv Mahajan; Walter P. Abhayaratna;Dennis H. Lau; Prashanthan Sanders Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, South Australia; Department of Cardiology, The Canberra Hospital, Canberra

  2. Obesity: Past and Projected Rate Proportion overweight Years Sassi et.al, OCED Publishing, 2014

  3. Projected Prevalence of AF 15.9 15.2 14.3 13.1 11.7 10.2 12.1 11.7 8.9 11.1 7.7 10.3 9.4 6.7 8.4 5.9 5.1 7.5 6.8 6.1 5.6 5.1 Projected number of persons with AF (millions) Year Miyasaka et.al Circulation 2006

  4. Probability of AF in Metabolic Syndrome HR 1.67 CI (1.49-1.87) Chamberlain et al, ARIC Study, AHJ 2010

  5. Effect of Short-Term Weight Loss Continuous Monitoring Symptom Burden Score P<0.001 P<0.001 P<0.001 Abed et al. JAMA 2013 min

  6. Hypothesis • Weight loss, if sustained, will be of incremental benefit in rhythm control • Weight fluctuation has detrimental effect Aims • Dose dependent effect of long term weight loss on freedom from AF • Impact of weight fluctuation • Role of dedicated clinic

  7. Outcomes Primary Outcomes • AF symptom burden: AFSS questionnaire • AF freedom: 7 days holter monitoring Secondary Outcomes • Structural parameters: LAV and LV thickness • Metabolic and inflammation profile

  8. Assessed for Eligibility N=1415 Patients with BMI ≥ 27 N=825 Met Exclusion Criteria (N=293) Terminal Cancer (N=10) Inflammatory Dx (N=20) Permanent AF (N=84) AV Node ablation (N=12) AF ablation (N=90) Severe Medical Illness (N=77) Weight Management Final Cohort N=355 Patients from other States (N=177) ≥10%WL N=135 3-9%WL N=103 <3%WL or WG N=117

  9. Baseline Characteristics

  10. Impact on Risk Factors

  11. Structural Remodeling hsCRPLevel LA Volume (Indexed) *Group-Time P<0.001 *Group-Time P<0.001 (mg/L) (ml/m2)

  12. Impact on AF Symptoms AF Symptom Burden Global Well Being Score *Group-Time P<0.001 *Group-Time P<0.001

  13. AF Freedom: Drug & Ablation-Free P<0.001 46% 46% Without AAD or ablation 22% 13%

  14. Total Arrhythmia-Free Survival 86% 66% 40% With AAD and/or ablation P<0.001

  15. Effect of Weight Loss Trend Yearly Weight Trend (N=355) Linear Gain (N=24) Weight Fluctuation (N=179) Linear Weight Loss (N=141) Effect of Degree of Weight fluctuation 2-5%WF N=68 <2%WF N=54 >5%WF N=57

  16. Weight Loss Trend 76% 59% 38% With AAD and/or ablation P<0.001

  17. Effect of Weight Fluctuation 85% 59% 44% With AAD and/or ablation P<0.001

  18. Multivariate Predictors of AF Recurrence Weight Loss Weight Fluctuation >10% weight loss was associated with AF free survival: HR 5.9 [95% CI: 3.4-10.3] (P<0.001) >5% weight fluctuation was associated with AF recurrence: HR 2.1 [95% CI: 1.0-4.3.3](P<0.001)

  19. Implications of Dedicated Weight Loss Clinic Successful Weight Loss Weight Maintenance • 52 patients lost >10% weight in first year • 66% maintained WL • 85% of them attended WL clinic • 18 regained weight , only 2 (11%) attended clinic 85% WL Clinic 113(84%) 57% WL Clinic 35 (30%) WL Clinic Total Patients N=135 Total Patients N=103 Total Patients N=117 WL Clinic 30% WL Clinic 58 (57%) WL Clinic

  20. Conclusion • Sustained weight loss is associated with dose dependent reduction in AF burden and maintenance of sinus rhythm • >5% Weight fluctuation dampens the benefit conferred by weight loss • A dedicated clinic improves patient engagement, promoting treatment adherence, preventing weight regain and fluctuation

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