9 Key Primary Care Takeaways: American College of Cardiology 2015

Laurie Scudder, DNP, NP; John M. Mandrola, MD


April 10, 2015

In This Article

The Lessons for Primary Care From ACC 2015

A number of studies reported at the American College of Cardiology (ACC) 2015 meeting can and will affect primary care practice. Keeping up-to-date on relevant research presented at specialty conferences might be a good idea, but it's virtually impossible to do in the hectic, information-saturated world in which primary care is practiced. So we asked John Mandrola, MD, to provide a quick tour of the highlights from this year's meeting with implications for primary care practice.

1: A New Way to Treat Atrial Fibrillation?

The study. Obesity is a major health concern and atrial fibrillation (AF) a common comorbidity, with a greater AF burden in the most obese patients. Rajeev Pathek, MD (University of Adelaide, Australia) presented the 5-year follow-up results[1] of The Long-Term Effect of Goal Directed Weight Management on an Atrial Fibrillation Cohort (LEGACY) study at ACC. The study included more than 300 adults with AF and a body mass index (BMI) of at least 27 kg/m2.

The results. Results showed a dose-response relationship between weight loss and AF burden; the subgroup that had at least a 10% weight loss 1 year after completing a physician-led management program had more reductions in severe symptoms of AF than the groups who lost less weight, with a sixfold (95% confidence interval [CI], 3.4-10.3; P < .001) greater probability of arrhythmia-free survival. In fact, almost half (46%) of patients with this degree of weight loss remained free from AF without any rhythm-control strategies. Yo-yo changes in weight partially offset this benefit. Greater than 5% weight fluctuation was associated with a twofold (95% CI, 1.0-4.3; P = .02) increased risk for arrhythmia recurrence.

The implications for primary care. The results should change the entire approach to management of AF, according to Richard Fogel, MD, president of the Heart Rhythm Society, as quoted by John Mandrola, MD, in a commentary on Medscape. Whether this new data will encourage a change in reimbursement patterns for weight loss counseling and services provided in primary care remains to be seen. But the argument grows ever stronger with data like this. In a commentary on WebMD, Dr Mandrola explains how this group of clinicians helped patients lose weight. It's easier than you think.


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