Cardiac rehabilitation in atrial fibrillation patients treated with ablation
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Transcript of Cardiac rehabilitation in atrial fibrillation patients treated with ablation
Cardiac rehabilitation in atrial fibrillation patients treated with ablation
Rigshospitalet, The Heart Centre
Oslo 2013
Signe Stelling Risom RN, MSc, PhD student
Agenda
Atrial fibrillation (AF) patients• Atrial fibrillation - psychological and
physical state• Intervention studies improving
outcomesAfter ablation• How are patients doing after ablation?• Rehabilitation for AF patients treated
with ablation
Oslo 2013
Rigshospitalet, The Heart Centre
Atrial Fibrillation
AF affects 1.5 - 2 % of the population in the western countries. The incidence is increasing
AF TypesParoxysmal AF: 20 %Persistent AF: 24 %Permanent AF: 56 %
ESC Guidelines 2012,Zoni-Berisso et al. American Journal of Cardiology 2013
Atrial Fibrillation
The symptoms:
• fatigue• dyspnoea • decreased exercise
tolerance• palpitations• dizziness • syncope
AF increases the risk for:
• early death• apoplexia • other thrombo-embolic events • heart failure
ESC Guidelines 2010
AF and quality of life
General health Physical
function Mental health Social
function
0
20
40
60
80
100
SF-36 Quality of life across AF and other groups
AF patients
CHF patients
Post-MI patients
Healthy controls
After: P. Dorian et al. J Am Coll Cardiol 2000;36(4):1303-9.
Anxiety and depression
• The prevalence of depression and anxiety among patients with AF
• 1/3 of the patients with AF experience increased symptoms of anxiety and depression. That is persistent after 6 months.
Thrall et al. CHEST 2007: 132
Change in living• The patients choose to take it easy,
get a new more relaxing job, to hold a less stressful everyday life.
• Early retirement and a shorter working week is prioritized.
• Patients use a lot of energy and resources on avoidance behaviour.
Deaton et al. Heart Lung 2003: 32(5).Berg and Pedersen Tidsskrift for sygeplejeforskning, 2006:3.
AF and physical exercise
Atwood et al. American Heart Journal, 2007: 153, 4.
Nurse-led care clinics
Hendriks et al. European Heart Jounal 2012; 33, 2692-2699
Psychological interventions for patients with AF
Lakkireddy et al. JACC 2013 Vol. 61, No. 11
Physical exercise for patients with AF
N = 30, permanent AF
Intervention: 8 weeks exercise training 3/ week 1.25 hours in 2 months. 3*15 min aerobics at 70-90 % of HRmax
Results: Increased Cumulated work, Increased QoL, less AF symptoms.
Hegbom et al. Journal of Cardiopulmonary Rehabilitation 2006;26:24/29
Physical exercise for patients with AF
N = 49, permanent AF
Intervention: 12 weeks training, 3/week, 1.3 hours. 70 % of max exercise capacity.
Results: Increased work capacity (Watt, 6 MWT), decreased resting pulse, increased QoL
Osbak et al. J Rehabil Med, 2012: 44
Catheter Ablation treatment
A meta-analysis (2009): Overall succesrate: 77 %
Calkins H et al. 2009 Circ Arrhythm Electrophysiol
Sang et al. Clin.Cardiol. 2013: 36,1.
QoL after ablation
Wokhlu et al. JACC 2010: vol. 55 no. 21
Rigshospitalet, The Heart Centre
QoL based on rhythm control post ablation rhythm status
QoL after ablation
Physical exercise after ablation
No studies found
CopenHeartRFA
RCT, N = 210Randomised to: 12 weeks of physical exercise and
4 consultations with a specially trained nurse plus usual care OR usual care only.
Primary outcome: VO2 Peak, ergospirometry testing
Secondary outcome: self-assessed mental health, SF36
Inclusion status to day: 145 patients
SS Risom et al. 2013 BMJ Open. Feb 20;3(2).
Experiences from the CopenHeart study – after ablation
Atrial fibrillation
No control over own body
What can I do to prevent attacks
Warfarin treatment
Insecure about the future
Time -hospitalisation, communication
Affects their manhood – to be sick
Physical activity