Background Randomised trial, controlled study and international guidelines have advocated weight loss in AF patients with obesity as a means of attaining better AF burden control and maintenance of sinus rhythm. However, previous study required patients to undertake a highly structured weight management programme, detailed counselling, meal plans and behaviour modification. Aim To assess if weight-loss can be attained through a 5-minute, target-driven, physician-led counselling amongst overweight/obese patients referred AF ablation, without the need for intensive weight management programme. Subsequently to assess this can lead to better clinical outcomes (reduction in AF recurrence and readmission). Methods All patients referred for AF ablation in a tertiary centre over a 6-month period were included. Baseline weight and BMI at initial encounter plus weight and BMI at day of AF ablation were recorded. Optional physician-led counselling was provided, with aim for target weight loss of <10% or reduction of 3 point in BMI. Initial contact to AF ablation is 6 months. Clinical outcomes such as symptomatic AF >3 months post AF ablation and readmission for symptomatic AF were recorded. Follow-up duration of 6 months post ablation. Patients received counselling were designated Group 1, and those who did not were designated Group 2. Outcomes 146 new AF referrals for ablation seen over the 6-month period. 105 (71.9%) are paroxysmal AF, 37 (25.3%) are persistent, 4 permanent AF. Mean BMI 34.4 (+/- 5.1). Out of which, 76% have BMI > 30 (Obese), 47.6% possess BMI >35 (Morbidly obese), with 1 patient with BMI exceeding 50. 21.9% patients received physician-led counselling to lose weight. Basic demographics (age, gender), proportion of pAF and duration of AF, use of antiarrhythmic drugs were not statistically different between the two groups. Among AF patients receiving weight-loss counselling (Group 1), they have higher mean weight and BMI, 108kg (+/- 14.3) and BMI 33.7 (+/-4.3), as compared to those who did not received counselling (Group 2), 87.5kg (+/- 16.2) and BMI 29.5 (+/-4.3). At point of AF ablation, Group 1 has median weight loss of (-)4.5kg, mean reduction of BMI (-)2.0 points, while Group 2 has median weight gain of 3.6kg, increase of BMI 1.1 point. Overall statistically significant difference in weight change (p <0.001). Composite clinical outcomes at 6 months post ablation comprising recurrence of AF and readmission for symptomatic AF were higher in Group 2 as compared to Group 1, 38% vs 13% (p = 0.03). Summary This small cohort study suggests that concise physician-led weight loss counselling (without dietician-led meal plan or extensive weight loss programme) provided to AF patients with increased BMI can lead to significant weight loss and lower BMI in the run-up to AF ablation. This is also associated with statistically significant reduction in recurrence of AF and hospital re-admission.
MIEDIC,AL JOURNAL followed up for periods varying from three months to two years, and, although it has not been possible to obtain follow-up blood pictures, in no cases have symptoms returned. DiscussionThe fact that these cases of anaemia are labelled idiopathic indicates that their aetiology is obscure. A combination of factors has probably rendered insufficient the amount of iron available for haemoglobin synthesis. It is less likely that there was an excessive iron loss by way of chronic' haemorrhage, although the possibility that this had occurred in the past cannot be ruled out. The deficiency of hydrochloric acid in the gastric secretions was probably one of the determining factors, but it cannot have been the primary cause, as four of the patients were not achlorhydric. Also, as noted by Davidson and Fullerton (1938), not all achlorhydric people are anaemic, and, whereas the incidence of achlorhydria increases with advancing years, idiopathic hypochromic anaemia in old people is rare.The possibility that the anaemia in Case 9 was a toxic manifestation of lead has already been considered. We have also pointed out that all but one of the men had less than three months' service. Probably the amount of extra physical exertion involved in their basic training was sufficient to produce symptoms in subjects previously anaemic but hitherto symptomless. This certainly was true of Case 20, in which the gross degree of koilonychia was evidence of a long-standing anaemia, and also of Case 5, in which an anaemic state had been demonstrated twelve months previously.There is, however, a further possible explanation. Cantarow (1947) states that 23% of the minimal iron intake is required for the manufacture of muscle haemoglobin and for use in muscle and other parenchymal cells. This iron is not available for blood haemoglobin formation, and blood haemoglobin may constitute an important source of iron necessary for growth. Davidson et al. (1933) have shown that persons with achlorhydria exist on an intake of iron which is very near the borderline. In most cases the first few months of the recruits' lives in the Army are accompanied by a marked increase in weight, due, in part, to enhanced development and hypertrophy of the musculature. This change is more pronounced in those previously immature and of poor physique. It may be that this abnormal demand for iron cannot be met by increased intake, on account of impaired absorption from the gut, and iron for the enhanced development is obtained at the expense of the blood haemoglobin. Thus either an anaemic state is produced or a latent anaemia is rendered obvious. SummaryAn account is given of 20 cases of idiopathic hypochromic anaemia occurring in young men.The majority of. cases showed a definite tendency to immaturity, and nail changes were present in some. The typical syndrome of hypochromic anaemnia as it occurs in women was not seen.Achlorhydria or hypochlorhydria was present in 16 of the cases. Of the remainder, normal gastric acidity was present in one and hyperchl...
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