Evaluating if lifestyle interventions are addressed in patients with atrial fibrillation

Aims: Atrial fibrillation is a common heart rhythm disorder, which can negatively affect quality of life and may lead to heart failure and stroke. A number of studies internationally have confirmed that lifestyle changes which target weight loss, physical activity and risk-factor modification have a positive influence on decreasing atrial fibrillation burden. Patient education regarding atrial fibrillation and the association of reversible risk factors can reduce this burden, but provision is often sporadic and inadequate. In 2020, the European Society of Cardiology updated its guidelines for the diagnosis and management of atrial fibrillation and included new recommendations for lifestyle interventions. This study aimed to investigate whether lifestyle interventions are addressed within local practice, in accordance with best practice guidelines for patients with atrial fibrillation. Methods and results: A clinical audit was performed to evaluate the provision of lifestyle interventions. This involved a retrospective review of 100 electronic patient records of patients with atrial fibrillation seen in the arrhythmia outpatient clinic at a tertiary centre, commencing December 2020. Data collection included age, gender, ethnicity, atrial fibrillation classification, appointment type, CHA 2 DS 2 –VASc score, body mass index and the healthcare professional undertaking the consultation. Review of whether lifestyle intervention was discussed was considered with regard to key areas included in the guidelines (weight loss, alcohol intake, caffeine intake, physical activity) or whether more than one lifestyle intervention was discussed. Only 34% of the sample had lifestyle interventions addressed. Of this 34%, 13 (38.24%) included weight-loss discussion; 4 (11.76%) included alcohol discussion; 1 (2.94%) included caffeine discussion; 4 (11.76%) included physical-activity discussion; and 12 (35.29%) included discussion on more than one lifestyle intervention. Only 5 (14.71%) had been provided with generic advice covering all recommended lifestyle interventions. Conclusions: The audit findings highlighted inconsistencies in implementing the guideline recommendations in local clinical practice when reviewing patients with atrial fibrillation in the outpatient setting. Alternative ways to provide this information need to be considered in view of the increased volume of patients and service demand, as well as limited time and resources.