Meta-analysis of Effect of Modest (≥10%) Weight Loss in Management of Overweight and Obese Patients With Atrial Fibrillation

Abstract

Obesity and atrial fibrillation (AF) are growing epidemics with significant overlap in co-morbidities. Multiple smaller studies have evaluated the effects of weight loss and risk factor modification on recurrence of AF, reduction in AF burden and improvement in AF symptom severity. The objective of this study was to determine if a modest weight loss of ≥10% of initial body weight is enough to improve outcomes in overweight or obese patients with established AF. We performed an extensive literature search and systematic review of studies that compared weight loss of ≥10% versus weight loss of less than 10% or weight gain and assessed outcomes including recurrence of AF as determined through a Holter monitor, AF burden and improvement in AF symptom severity. Risk ratio 95% confidence intervals (CI) were measured for dichotomous variables and mean difference (MD) 95% CI were measured for continuous variables, where MD >0 favors the group with ≥10% weight loss. Five studies with a total of 548 patients were included. Patients who lost ≥10% of their initial body weight experienced less recurrence of AF (risk ratio 0.29; 95% CI 0.19 to 0.44) and a larger reduction in reported event frequency (MD 1.74; 95% CI 0.70 to 2.79), episode duration (MD 2.14; 95% CI 0.04 to 4.23), global episode severity (MD 1.89; 95% CI 1.34 to 2.45), and symptom severity (MD 5.36; 95% CI 3.75 to 6.97). In conclusion, weight loss is associated with less risk of recurrent AF, reduction in AF burden, and improvement in AF symptom severity.

Figure 1.

Selection of studies

Figure 2.

Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies, according Cochrane Handbook for Systematic Reviews of Interventions.

Figure 3.

Risk of bias summary: review authors’ judgements about each risk of bias item for each included study, according Cochrane Handbook for Systematic Reviews of Interventions.

Figure 4.

Forrest plots and funnel plots for the comparative analysis of risk of recurrent atrial fibrillation in those who lost 10% or more of their body weight compared to those who lost less than 10% of their body weight or gained weight from baseline to follow up.

Figure 5:

Forrest plots for the comparative analysis of the reduction in the various components of the Atrial Fibrillation Severity Scale scores in those who lost 10% or more of their body weight compared to those who lost less than 10% of their body weight or gained weight from baseline to follow up. A) event frequency, B) episode duration, C) global episode severity, D) symptom severity.