Canberra Heart Rhythm Centre

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Aggressive management of risk factors may be the key to improving patient outcomes following ablation for atrial fibrillation. Findings published Dec. 2 in the Journal of the American College of Cardiology suggest that in patients with a high body mass index and more than one cardiovascular risk factor, improved long-term outcomes are possible when several risk factors were addressed.

A nearly three-fold greater number of aggressively managed patients were free of arrhythmia at final follow-up, researchers found.

The Aggressive Risk Factor Reduction Study for Atrial Fibrillation (ARREST-AF) cohort study followed 61 risk-factor managed (RFM) patients and 88 control patients for a mean of 41.6 vs. 42.1 months, respectively.

Rajeev K. Pathak, MBBS, of the Royal Adelaide Hospital in Adelaide, Australia, and colleagues of the ARREST-AF study sent patients in the RFM group to a physician-directed clinic every three months on top of arrhythmia follow-ups. Patients were given instruction on structured weight management programs; thrice-daily home blood pressure monitoring; lifestyle advice and behavior modification; smoking cessation counseling; sleep-disordered breathing management; and pharmaceutical treatment for lipids, blood pressure and glucose, if needed.

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There are many reasons doctors suffer from burnout and compassion fatigue. One of the least-mentioned of these reasons is that much of what we do is so damned unnecessary. In the US, the land of excess everything, caregivers, especially cardiologists, spend most of our time treating human beings who didn't need to have disease.

Let's be clear and honest: Lifestyle-related disease is largely unnecessary.

These days, there is so much unnecessary disease that caregivers, especially cardiologists, rarely see it. We look past the obesity right to the cholesterol number and ECG. And then we pull out the prescription pad for the guideline-directed pills. Just typing that causes me angst.

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