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TOPLINE:

Older patients with persistent atrial fibrillation (AF) who followed a diet-based weight-loss program for 8 months lost more weight than those who received usual care. The patients maintained a lower weight over 3 years but did not experience a reduction in the severity of AF symptoms.

METHODOLOGY:

• Researchers conducted an open-label randomized clinical trial at two hospitals in the UK to assess whether weight loss from a low-calorie diet alleviated AF-related symptoms in older adults.
• They included 118 patients aged 60-85 years with persistent AF and a BMI of 27 or higher who were referred for cardioversion between November 2018 and April 2025.
• Patients were randomly assigned to an intervention group that received an 8-month low-calorie diet with regular behavioral support (n = 59; mean age, 68.5 years; 66% male) or to a usual care group that received a single face-to-face nurse consultation and written advice on diet (n = 59; mean age, 68.3 years; 68% male).
• The primary outcome was a reduction in the severity of AF symptoms, measured using a subscale of the AF severity scale ranging from 0 to 35, with higher scores representing greater severity. Secondary outcomes included AF burden, body weight, and physical performance.
• Researchers completed primary and secondary evaluations at 8 months, with an interim review at approximately 4 months. In an exploratory analysis, they captured long-term data on weight and symptoms over a mean duration of 3.5 years.

TAKEAWAY:

• At 8 months, patients in the intervention group lost 6.9 kg more than those in the usual care group, corresponding to a weight reduction of 9.7% vs 3.1% (P < .001).
• Severity scores for AF symptoms did not differ significantly between the intervention and usual care groups at 4 and 8 months.
• Researchers observed no significant differences between the groups in the burden of AF, freedom from AF, physical performance, cardiac MRI measures, health-related quality of life, blood pressure, or lipid levels. No serious adverse events related to the intervention were reported.
• At 3.5 years, patients in the intervention group had significantly lower weight than those in the usual care group (P < .001), with an estimated difference of 4.9 kg. However, no long-term differences were observed in severity scores for AF symptoms.

IN PRACTICE:

“Rather than taking findings from the current study as supporting inaction with respect to weight loss, these current data, alongside prior evidence, may spur on a sense of urgency to help patients with healthy lifestyle choices as soon as an atrial fibrillation diagnosis is made,” Gregory M. Marcus, MD, MAS, wrote in an accompanying editorial.

SOURCE:

The study was led by Matteo Sclafani, MD, John Radcliffe Hospital, Oxford, England. It was published online on May 20 in JAMA.

LIMITATIONS:

The trial was open-label. Some assessments could not be conducted for all participants because of the COVID pandemic. Weight loss was moderate and was likely too small to produce substantial improvements in blood pressure, lipid levels, or levels of C-reactive protein.

DISCLOSURES:

The study was sponsored by the University of Oxford and received funding from the National Institute for Health and Care Research Oxford Biomedical Research Centre, the British Heart Foundation, and the DigiCardiopaTh PhD program. Multiple authors reported receiving research grants or fellowship support from public and private funding sources. One author reported the in-kind provision of ECG patch monitors for a separate trial and service on a charitable foundation board. One author reported serving as editor in chief of JAMA Cardiology.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.