Interventions to control risk factors and effectiveness to reduce incident and recurrent AF15 19
| Clinical factor | Years | Intervention | Patients (n) | Characteristics | Follow-up | Changes in risk* |
| Physical activity | 2015 | Exercise programme to improve cardiorespiratory fitness | 1415 | Patients with AF treated with rhythm control | 4.1 years | HR 0.87, 95% CI 0.80 to 0.94 for AF recurrence for each additional MET achieved HR 0.90, 95% CI 0.83 to 1.00 for AF recurrence for each MET gained |
| Diabetes mellitus | 2014 | Metformin use Intensive versus standard glucose control | 6 45 710 10 082 | Patients with diabetes without AF | 13 years 4.68 years | HR 0.81, 95% CI 0.76 to 0.86 for metformin Use No reduction of AF incidence in intensive glucose control group |
| Hypertension | 2005–2015 | Use of blood pressure-lowering drugs (ACEi, ARBs) | 8 47 388 | Hypertensive patients in primary or secondary prevention for AF occurrence (with/without structural heart disease) | 1–6.8 years | ACEi or ARBs do not affect AF risk in hypertensive patients without structural heart disease ACEi and ARBs reduce risk for AF in patients with HF or LVH HR 0.22–0.84 |
| Obesity | 2013–2016 | Weight management intervention Bariatric surgery | 5586 | Obese patients in primary or secondary prevention for AF | 1.2–19 years | Patients with lower weight reduction (<3% or 3%–9%) had higher risk for AF recurrence compared with those with higher weight reduction (≥10%): HR 2.0 and HR 3.0 respectively (also weight management reduces general AF burden) Bariatric surgery reduces risk for AF occurrence (HR 0.69) |
*All HR reported are statistically significant, except where reported.
ACEi, ACE inhibitor; AF, atrial fibrillation; ARBs, angiotensin receptor blockers; HF, heart failure; HR, HR ratio; LVH, left ventricular hypertrophy; MET, metabolic equivalent of task.