TY - JOUR
T1 - Implications of the LEGACY trial on US Atrial Fibrillation Patients
T2 - An NCDR Research to Practice (R2P) Project
AU - Gehi, Anil K.
AU - O'Brien, Emily
AU - Pathak, Rajeev K.
AU - Sanders, Prashanthan
AU - Kennedy, Kevin F.
AU - Virani, Salim S.
AU - Masoudi, Frederick A.
AU - Maddox, Thomas M.
N1 - Funding Information:
Dr. Pathak is supported by a Postgraduate Fellowship from the National Health and Medical Research Council of Australia. Dr. Sanders is supported by Practitioner Fellowships from the National Health and Medical Research Council of Australia and by the National Heart Foundation of Australia. Dr. Gehi reports having received lecture fees from Medtronic, St. Jude Medical, Biotronik, and Zoll. Dr. O'Brien reports receiving research funding from Janssen, Merck, Novartis, GSK, and Bristol-Myers Squibb and serving as a consultant to Portola Pharmaceuticals. Dr. Sanders reports having served on the advisory board of Biosense-Webster, Medtronic, St. Jude Medical, Boston Scientific, and CathRx and having received lecture and/or consulting fees from Biosense-Webster, Medtronic, and St. Jude Medical. Dr. Sanders reports having received research funding from Medtronic, St. Jude Medical, Boston Scientific, Biotronik and Sorin. Dr. Masoudi has a contract with the American College of Cardiology for his role as the Chief Science Officer of the NCDR programs. The other authors have no conflicts of interest to report.
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2017/2/15
Y1 - 2017/2/15
N2 - The Long-term Effect of Goal Directed Weight Management in an Atrial Fibrillation Cohort: A Long-term Follow-up Study (LEGACY) demonstrated that weight reduction in a cohort of Australian patients with atrial fibrillation (AF) resulted in a reduction in AF burden and improvement in AF symptom severity. The applicability of LEGACY in US cardiovascular practice is not known. A cohort of patients with AF from the National Cardiovascular Data Registry Practice Innovation and Clinical Excellence (PINNACLE) registry of US cardiovascular ambulatory care practices was created. The proportion of PINNACLE AF patients meeting enrollment criteria for LEGACY was assessed. Differences between these patients and LEGACY trial patients were qualitatively compared. Treatment for AF among LEGACY eligible and noneligible patients was compared. Among 349,999 US patients with AF from 179 cardiovascular practices in the PINNACLE registry, 197,255 (56.4%) met enrollment criteria for LEGACY. LEGACY-eligible PINNACLE AF had significantly lower rates of tobacco and alcohol abuse than the LEGACY trial population. There were significant differences in drug therapy comparing LEGACY eligible and LEGACY noneligible PINNACLE AF patients. In this cohort of patients in ambulatory practice in the United States with AF, over 1/2 were potential candidates for a weight management program. Differences between patients in practice and those enrolled in the trial could influence the success and impact of the LEGACY weight management intervention. Our study identifies a potential opportunity to improve AF morbidity and costs to the health care system in the United States by implementing a structured weight reduction program, such as that described in LEGACY.
AB - The Long-term Effect of Goal Directed Weight Management in an Atrial Fibrillation Cohort: A Long-term Follow-up Study (LEGACY) demonstrated that weight reduction in a cohort of Australian patients with atrial fibrillation (AF) resulted in a reduction in AF burden and improvement in AF symptom severity. The applicability of LEGACY in US cardiovascular practice is not known. A cohort of patients with AF from the National Cardiovascular Data Registry Practice Innovation and Clinical Excellence (PINNACLE) registry of US cardiovascular ambulatory care practices was created. The proportion of PINNACLE AF patients meeting enrollment criteria for LEGACY was assessed. Differences between these patients and LEGACY trial patients were qualitatively compared. Treatment for AF among LEGACY eligible and noneligible patients was compared. Among 349,999 US patients with AF from 179 cardiovascular practices in the PINNACLE registry, 197,255 (56.4%) met enrollment criteria for LEGACY. LEGACY-eligible PINNACLE AF had significantly lower rates of tobacco and alcohol abuse than the LEGACY trial population. There were significant differences in drug therapy comparing LEGACY eligible and LEGACY noneligible PINNACLE AF patients. In this cohort of patients in ambulatory practice in the United States with AF, over 1/2 were potential candidates for a weight management program. Differences between patients in practice and those enrolled in the trial could influence the success and impact of the LEGACY weight management intervention. Our study identifies a potential opportunity to improve AF morbidity and costs to the health care system in the United States by implementing a structured weight reduction program, such as that described in LEGACY.
UR - http://www.scopus.com/inward/record.url?scp=85009274784&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2016.10.044
DO - 10.1016/j.amjcard.2016.10.044
M3 - Article
C2 - 28038724
AN - SCOPUS:85009274784
SN - 0002-9149
VL - 119
SP - 579
EP - 584
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 4
ER -