Rehabilitation of Patients With Atrial Fibrillation
Condition: Atrial Fibrillation
MeSH terms: Atrial Fibrillation
Study type: Interventional

Summary: 
      The purpose of this study is to investigate whether a rehabilitation programme can improve
      the quality of life and reduce morbidity in patients with atrial fibrillation.

      In addition, the study will map the economic costs and benefits of such a rehabilitation
      programme.
    

Detailed description: 
      Atrial fibrillation (AF) is the most frequent cardiac arrhythmia and is the cause of
      increased morbidity, mortality and socioeconomic costs.

      Research conducted in recent years suggests that various pharmacological therapies and life
      style changes may affect the structural remodelling, thereby preventing the incidence of AF
      (primary prophylaxis) and a progression of the disease (secondary prophylaxis). These
      therapies, known as upstream therapy, include ace inhibitors/angiotensin II inhibitors,
      statins, the intake of n-3 polyunsaturated fatty acids and moderate physical exercise.

      Furthermore, an important part of the treatment is to alleviate patients' symptoms, reduce
      the risk of thromboembolic complications and teach the patients to live with a chronic
      paroxysmal disease. Today, well-established pharmacological therapies are available, but
      there is only sparse knowledge of the effect of non-pharmacological therapies, how patients
      obtain information on the disease, how they learn how to cope with their symptoms, and how
      they relate to the uncertainty as to when they will experience the next symptom-producing
      attack of AF.

      Cardiac rehabilitation is a collective term for the aftercare of patients with chronic heart
      failure. Cardiac rehabilitation is a cross-functional approach with participation of
      physicians, nurses, dieticians and smoking cessation instructors and is performed under the
      supervision of a cardiac specialist.

      Cardiac rehabilitation includes: individually designed treatment plan, offer of patient
      information and education, support for smoking cessation, support for diet change,
      psychosocial support, optimisation of medical treatment and risk factor control, advice on
      physical exercise and maintenance of targets.

      There is strong evidence that rehabilitation has a beneficial effect on the quality of life,
      but also on morbidity and mortality from other heart diseases than AF.

      Currently, patients with the diagnosis of AF are not offered a rehabilitation programme, and
      there is sparse knowledge of the effect of rehabilitation on patients' quality of life and
      morbidity.

      It is therefore of vital importance to develop and implement a rehabilitation programme aimed
      at improving the quality of life of patients with AF and, possibly, preventing admissions and
      the development of AF.

      All participants are examined by exercise ECG to assess their maximum physical capacity
      (estimated oxygen uptake), Six-minute-walk test and Five-repetition-sit-to-stand test at
      inclusion and after 3 and 6 months.

      At inclusion and at the end of the study each participant is to complete the QOL
      questionnaire, AF-QOL-18 and AFEQT, and questionnaire on lifestyle, heart symptoms, risk
      factors, medical treatment and sickness absence, if any, visits to own GP due to AFLI and
      hospital admissions.

      The resource consumption for each individual participant is regularly recorded. Instructors
      and physiotherapists record their total time consumption (preparation and confrontation time)
      as well as patients' total time consumption (transportation and time for education/exercise.
      Furthermore, travel expenses in relation to rehabilitation are recorded. In addition the
      patients are to complete a questionnaire on lifestyle (Euroqol eq-5d) at inclusion and after
      1, 3, 6 and twelve months, respectively, for use in the cost-benefit analysis. Data on visits
      to own GP are collected from the Danish Health Insurance Registry at the end of the study.
    

Intervention name(s): Cardiac rehabilitation; Standard treatment
Intervention type(s): Other; Other
Intervention description(s): AF specific cardiac rehabilitation Group education 1 hour each week for 3 months Physical training 1 hour each week for 3 months with physiotherapist; Standard treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Rehabilitation