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Is This Treatment a Game-Changer for AFib?

By John Mandrola, MDMarch 24, 2015
From the WebMD Archives

There was big news in the world of cardiology last week – news that will change the way heart doctors approach the care of patients with the common heart rhythm disorder atrial fibrillation.

It was not a new drug or procedure. It was much simpler. The new discovery was the power of weight loss—and its effect on the human heart. The news was released at the annual meeting of The American College of Cardiology. The meeting featured thousands of presentations of cutting-edge science, yet the most important news was basic.

In the Legacy study, a group of heart rhythm doctors from Adelaide Australia reported that patients who lost more than 10% of their body weight enjoyed lower blood pressure and cholesterol levels, improved control of blood sugar and less heart rhythm problems. And they achieved these things while taking fewer pills.

But that’s not the best part.

The best part was that the researchers showed us how to help patients lose weight. Their secret sauce is a special clinic where patients meet with a doctor who does nothing else but work on lifestyle factors.

The senior investigator, Dr. Prash Sanders told me that all overweight or obese patients with the heart rhythm problem atrial fibrillation who come to their hospital are also referred to a separate lifestyle clinic.

That sounds fancy, but it is not. Dr. Sanders says the lifestyle (or risk factor) clinic is just one patient and one doctor who meet in a standard exam room. There are no props–no waterfalls, soft music or fancy diets. A doctor and patient work together on the basics.

They keep it simple.

Patients are first told that weight loss will help them feel better and avoid pills or surgery. This consistent message serves as motivation. Patients understand that weight loss is not extra but central to their treatment.

Next up are small goals. Patients are not told to lose 40 pounds right away. Instead, they are given small milestones. Small things add up to big gains, goes the thinking.

Dietary advice is key. A food diary reveals easy places to start. Patients are advised to eat smaller portions, cut down on sugary carbs and decrease alcohol intake. Pardon the cliché, but this is low-hanging fruit.

Regular exercise is recommended. Patients are given a written prescription for exercise, as if it was a pill.

Another key is follow-up and support. The Australian research team base this strategy on findings from prior research, which shows patients given long-term support are more likely to achieve durable weight loss.

Finally, the doctor in the risk factor management sees to it that blood pressure, blood sugar and cholesterol levels are treated. Patients are screened for sleep disorders and strongly counseled on smoking cessation.

This study and its remarkable results changes everything.

Dr. Valentine Fuster is a distinguished global leader in cardiology and the editor of a major cardiology journal. He called Legacy the most important study of the meeting. So did Dr. Richard Fogel, the president of the Heart Rhythm Society. Fogel stopped me in the hallway of the meeting. He had a look of epiphany on his face when he said: “John…maybe instead of talking to my patients about drugs and procedures, I should be talking to them about weight loss.”

One of the questions raised in the press conference was how can we afford to give this sort or personalized care to the millions of patients with atrial fibrillation? Dr Sanders’ response was…

How can we afford not to?

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