Key patient and health outcomes in Atrial Fibrillation (AF) may be improved through a comprehensive exercise-based rehabilitation programme to address the management of risk factors associated with the progression of AF. Additionally, large, randomised trials are needed to enable us to explore the impact on other outcomes, such as mortality, cerebrovascular events, and cardiac hospitalisations. At present there is a lack of such an intervention. Our study attempts to investigate the efficacy of an exercise-based rehabilitation programme with patient education for AF patients undergoing first-time AF ablation.
Over the last few years our understanding of AF has increased. While certain risk factors and predisposing conditions cannot be changed (such as age, ethnicity, gender, or genetics), several risk factors can be modified and managed. These include: obesity, smoking, excess alcohol consumption, hypertension, diabetes, physical inactivity, and obstructive sleep apnoea. Many of these risk factors are similar to risk factors for other cardiovascular diseases such as ischaemic heart diseases, vascular disease, and heart failure. Patients suffering from these conditions are offered therapies which include risk factor adjustment and lifestyle management such as cardiovascular rehabilitation. However, current guidelines for patients undergoing AF ablation do not mandate referral for integrated therapies to manage these risk factors. Targeting these modifiable risk factors as early as possible in AF patients who have failed medical therapy could potentially reduce AF burden, reverse atrial remodelling and limit AF progression following an AF ablation procedure. It may also improve underlying co-morbidity and in turn reduce stroke and other cardiovascular adverse events.
We aim to explore the effectiveness of a tailored comprehensive cardiac rehabilitation programme (both before and after the planned AF ablation) comprising of an exercise programme and patient education programme incorporating lifestyle behaviour change (CREED AF intervention). The education programme will centre on risk factor analysis with individualised risk factor targeting. This will include weight reduction support, advice on alcohol consumption and smoking cessation support. There will be risk factor modification to optimise hypertension/diabetes control, assess for presence of obstructive sleep apnoea with onward referral if needed, and advice on regular exercise. The education sessions will integrate a psychosocial well-being component to support self-management.