Effects of a simple cardiac rehabilitation program on improvement of self-reported physical activity in atrial fibrillation – Data from the RACE 3 study

Nguyen, Bao; Wijtvliet, Petra; Hobbelt, Anne H; Vries, Simone I M De; Smit, Marcelle D.; Tieleman, Robert G; Veldhuisen, Dirk J. van; Crijns, Harry J.G.M.; Gelder, Isabelle C. Van; Rienstra, Michiel; Investigators, Race

doi:10.1016/j.ijcha.2020.100673

Cited by 4 publications

(2 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 10 , 15 Even though our cardiac rehabilitation programme was simply implementable to get patients active, the short supervised period, absence of weight reduction, and the comparable outcome on physical activity in both groups at 5 years could have contributed to the lack of benefit of targeted therapy. 16 Keeping patients physically active remains difficult. 17 More intensive counselling and extension of supervised exercise in the 5-year follow-up possibly could have improved outcome on physical activity and consequently maintain the weight loss and BMI reduction as seen at 1-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of targeted therapy of underlying conditions in patients with early persistent atrial fibrillation and heart failure: data of the RACE 3 trial

et al. 2021

Self Cite

View full text Add to dashboard Cite

Aims The Routine vs. Aggressive risk factor driven upstream rhythm Control for prevention of Early persistent atrial fibrillation (AF) in heart failure (HF) (RACE 3) trial demonstrated that targeted therapy of underlying conditions improved sinus rhythm maintenance at 1 year. We now explored the effects of targeted therapy on the additional co-primary endpoints; sinus rhythm maintenance and cardiovascular outcome at 5 years. Methods and results Patients with early persistent AF and mild-to-moderate stable HF were randomized to targeted or conventional therapy. Both groups received rhythm control therapy according to guidelines. The targeted group additionally received four therapies: angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers (ARBs), statins, mineralocorticoid receptor antagonists (MRAs), and cardiac rehabilitation. The presence of sinus rhythm and cardiovascular morbidity and mortality at 5-year follow-up were assessed. Two hundred and sixteen patients consented for long-term follow-up, 107 were randomized to targeted and 109 to conventional therapy. At 5 years, MRAs [76 (74%) vs. 10 (9%) patients, P < 0.001] and statins [81 (79%) vs. 59 (55%), P < 0.001] were used more in the targeted than conventional group. Angiotensin-converting enzyme inhibitors/ARBs and physical activity were not different between groups. Sinus rhythm was present in 49 (46%) targeted vs. 43 (39%) conventional group patients at 5 years (odds ratio 1.297, lower limit of 95% confidence interval 0.756, P = 0.346). Cardiovascular mortality and morbidity occurred in 20 (19%) in the targeted and 15 (14%) conventional group patients, P = 0.353. Conclusion In patients with early persistent AF and HF superiority of targeted therapy in sinus rhythm maintenance could not be preserved at 5-year follow-up. Cardiovascular outcome was not different between groups. Trial registration number Clinicaltrials.gov NCT00877643.

show abstract

Section: Discussionmentioning

confidence: 99%

Long-term outcome of targeted therapy of underlying conditions in patients with early persistent atrial fibrillation and heart failure: data of the RACE 3 trial

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…[1] A few studies recommend 150 min/week of moderate activity for having a positive benefit on human health status. [1] , [2] , [3] Fitness tracker in combination with smart phone and app-based data collection provide continuous, objective, remote monitoring of physical activity. [4] , [5] Recent data suggest a significant reduction in physical activity during the COVID-19 related in-home confinement in normal population and in patients with implantable cardioverter-defibrillators.…”

Section: Introductionmentioning

confidence: 99%

Effect of first and second German COVID-19 lockdown on physical activity in patients after pulmonary vein isolation

Meretz

Seifert

Moeller

et al. 2021

IJC Heart & Vasculature

View full text Add to dashboard Cite

Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study

Misra,

Niazi,

Swayampakala

et al. 2023

JMIR Cardio

View full text Add to dashboard Cite

Background Risk factor modification, in particular exercise and weight loss, has been shown to improve outcomes for patients with atrial fibrillation (AF). However, access to structured supporting programs is limited. Barriers include the distance from appropriate facilities, insurance coverage, work or home responsibilities, and transportation. Digital health technology offers an opportunity to address this gap and offer scalable interventions for risk factor modification. Objective This study aims to assess the feasibility and effectiveness of a 12-week asynchronous remotely supervised exercise and patient education program, modeled on cardiac rehabilitation programs, in patients with AF. Methods A total of 12 patients undergoing catheter ablation of AF were enrolled in this pilot study. Participants met with an exercise physiologist for a supervised exercise session to generate a personalized exercise plan to be implemented over the subsequent 12-week program. Disease-specific education was also provided as well as instruction in areas such as blood pressure and weight measurement. A digital health toolkit for self-tracking was provided to facilitate monitoring of exercise time, blood pressure, weight, and cardiac rhythm. The exercise physiologist remotely monitored participants and completed weekly check-ins to titrate exercise targets and provide further education. The primary end point was program completion. Secondary end points included change in self-tracking adherence, weight, 6-minute walk test (6MWT), waist circumference, AF symptom score, and program satisfaction. Results The median participant age was 67.5 years, with a mean BMI of 33.8 kg/m2 and CHADs2VASC (Congestive Heart Failure, Hypertension, Age [≥75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female]) of 1.5. A total of 11/12 (92%) participants completed the program, with 94% of expected check-ins completed and 2.9 exercise sessions per week. Adherence to electrocardiogram and blood pressure tracking was fair at 81% and 47%, respectively. Significant reductions in weight, waist circumference, and BMI were observed with improvements in 6MWT and AF symptom scores (P<.05) at the completion of the program. For program management, a mean of 2 hours per week or 0.5 hours per patient per week was required, inclusive of time for follow-up and intake visits. Participants rated the program highly (>8 on a 10-point Likert scale) in terms of the impact on health and wellness, educational value, and sustainability of the personal exercise program. Conclusions An asynchronous remotely supervised exercise program augmented with AF-specific educational components for patients with AF was feasible and well received in this pilot study. While improvements in patient metrics like BMI and 6MWT are encouraging, they should be viewed as hypothesis generating. Based on insights gained, future program iterations will include particular attention to improved technology for data aggregation, adjustment of self-monitoring targets based on observed adherence, and protocol-driven exercise titration. The study design will need to incorporate strategies to facilitate the recruitment of a diverse and representative participant cohort.

show abstract

Effects of a simple cardiac rehabilitation program on improvement of self-reported physical activity in atrial fibrillation – Data from the RACE 3 study

Cited by 4 publications

References 18 publications

Long-term outcome of targeted therapy of underlying conditions in patients with early persistent atrial fibrillation and heart failure: data of the RACE 3 trial

Long-term outcome of targeted therapy of underlying conditions in patients with early persistent atrial fibrillation and heart failure: data of the RACE 3 trial

Effect of first and second German COVID-19 lockdown on physical activity in patients after pulmonary vein isolation

Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study

Contact Info

Product

Resources

About