Reversal of Atrial Substrate to Prevent Atrial Fibrillation Cohort Study
- Conditions
- Atrial Fibrillation, Paroxysmal or Persistent
- Registration Number
- NCT06249269
- Lead Sponsor
- Ratika Parkash
- Brief Summary
Atrial fibrillation (AF) is a major health problem, with a prevalence of 0.4-1% of the population. It results in high healthcare costs and significant morbidity, especially for patients with severe symptoms. The RASTA-AF randomized control trial (RCT) is designed to answer the following question: does vigorous treatment of AF with aggressive risk factor management plus catheter ablation reduce AF-related outcomes as compared to catheter ablation plus usual care in patients with symptomatic AF and risk factors that promote AF.
This study is a multicenter, prospective cohort study that will enrol patients who decline participation in the RASTA-AF RCT but agree to be followed in a registry. The objective of RASTA-Cohort is to determine whether patients who decline participation in the RASTA-AF RCT have different clinical characteristics and quality of life than patients who accept participation in the study, and whether they suffer from worse AF-related outcomes than patients in the RCT.
- Detailed Description
Randomized clinical trials remain the gold standard for determining the efficacy of an intervention, however, it is well known that patients will decline participation in clinical trials for various reasons. It is critical to understand outcomes of patients who are eligible for a clinical trial, but decline participation, as it may affect the magnitude of an intervention, and ultimately its clinical meaningfulness. The RASTA cohort study will address this issue in patients with AF. Atrial fibrillation has become a significant burden globally, and is more often present in older individuals. This is particularly important in Nova Scotia where our healthcare system is especially burdened as the population ages, 20% of the current population is \>65 years. Improved understanding of the AF patient population in Nova Scotia, and beyond, will permit further understanding of how best to treat this increasingly common chronic illness.
The RASTA-Cohort study is designed to answer the following questions:
1. Do patients who decline participation in the RASTA AF RCT have different clinical characteristics and quality of life than patients who accept participation in the study.
2. Do patients who do not participate in the RASTA AF RCT suffer from worse AF-related outcomes than patients in the study, as compared to the control arm and intervention arm.
This is a multicenter, prospective cohort study that will enrol patients who are eligible for, but do not participate in the RASTA-AF study, but agree to be followed in this registry. Once the patient has consented to participate in RASTA Cohort, they will be scheduled for their AF ablation at the next available timeframe (2-4 months from entry into the study). All patients will continue to receive care as per current guidelines; this will be managed at the discretion of their treating physician.
Clinical characteristics collected at baseline include quality of life (CCS-SAF, AFEQT, EQ-5D), physical activity measures: IPAQ and stress test results (where available), blood pressure, weight, hemoglobin A1C, alcohol use and smoking cessation. The measures of risk factors will be performed in a similar fashion as the main study to ensure that these can be compared.
The conservative estimated event rate for the cohort is 20% greater than that of the control population of the RASTA AF study. Given the control population having an event rate of 30%, and the cohort group being 43.5%, a sample size of 313 patients is required in the control population of RASTA and 185 patients in the cohort group with a minimum 2 year follow up. Using a 7% loss to follow up rate, the sample size required in the cohort group is 198 patients. This sample size will provide 90% power with a type I error of 0.05 to detect a difference in survival between the cohort and the control group in the study. There is \>99% power to detect a difference between the intervention group and the cohort group based on the sample of 198 patients.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 198
- symptomatic AF (CCS-SAF ≥2),
- paroxysmal or persistent atrial fibrillation despite rate control, desiring catheter ablation and either: i) BMI ≥ 30 or, ii) at least two of the following: BMI>27, BP>140/90 mmHg or history of hypertension, Diabetes, Heart failure (prior heart failure admission or LVEF<40%), Age ≥ 65 years, Prior stroke/TIA, Current smoker, Excessive alcohol use {For women: 10 or more drinks/week, more than 2 drinks a day (most days). For men: 15 or more drinks/week, more than 3 drinks a day (most days)}, and iii) declined participation in the RASTA AF clinical trial.
- permanent AF (AF lasting > 3 years),
- prior catheter ablation for AF
- left atrial size > 5.5 cm,
- New York Heart Association Class IV heart failure
- participation in a cardiac rehabilitation program within the last year,
- currently performing exercise training >150 minutes/week of moderate to vigorous physical activity,
- unable to exercise,
- unable to give informed consent,
- other noncardiovascular medical condition making 1 year survival unlikely
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Number of patients with atrial fibrillation (AF) related ED visits Up to 48 months Defined as any presentation to the emergency department (less than 24 hours) due to: atrial fibrillation/atrial flutter, stroke/transient ischemic attack/systemic embolism, heart failure, syncope or bradycardia requiring pacing.
Number of patients with clinically significant atrial fibrillation post ablation Up to 48 months Clinically significant AF events lasting greater or equal to 24 hours with symptoms (either an irregular R-R interval or atrial cycle length less than 280 ms, as obtained from an insertable cardiac monitor) from 2 months post ablation to end of follow-up.
Number of patients with atrial fibrillation (AF) related hospitalizations Up to 48 months Defined as any hospitalization (greater than 24 hours) from 2 months post ablation to end of follow up due to: atrial fibrillation/atrial flutter, stroke/transient ischemic attack/systemic embolism, heart failure, syncope or bradycardia requiring pacing.
- Secondary Outcome Measures
Name Time Method Quality of Life - CCS SAF scale Up to 24 months Symptom burden as measured by the Canadian Cardiovascular Society (CCS) Severity of Atrial Fibrillation (SAF) Scale. CCS-SAF scores range from 0 to 4, with higher values representing more severe impact of AF-related symptoms on quality of life and activities of daily living.
Quality of Life Health Outcomes using EuroQol-5D-5L Up to 24 months The EQ-5D-5L quality of life questionnaire will be used to assess health related outcomes. The scale measures quality of life on a 5-component scale including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension in the EQ-5D-5L has five response levels: no problems (Level 1); slight; moderate; severe; and extreme problems (Level 5). The lower the number, the better the impact on quality of life.
Number of patients with gender association, Atrial fibrillation risk factors and risk factor management Up to 24 months GENESIS PRAXY Gender Questionnaire
Number of Deaths Up to 48 months Study Exit due to death from time of inclusion
Number of patients with a composite of AF-related hospitalizations and ED visits or clinically significant AF Up to 48 months Defined as any hospitalization or presentation to the emergency department due to: atrial fibrillation/atrial flutter, stroke/transient ischemic attack/systemic embolism, heart failure, syncope or bradycardia requiring pacing and/or clinically significant atrial fibrillation (greater than or equal to 24 hours with symptoms) from randomization to end of follow up.
Number of patients with stroke or systemic embolism Up to 48 months Hospitalization or treatment for a stroke or systemic embolism
Quality of Life - AFEQT Up to 24 months Quality of life scale as measured by the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) scale. The scale consists of 21 questions with 7-point Likert scale responses. Questions 1-18 are grouped into three subscales (symptoms, daily activities and treatment concern). Questions 19-21 capture satisfaction with treatment and are not included in the HRQoL score of the questionnaire. Overall and subscale scores range from 0 to 100. Lower cores correspond to higher levels of disability (e.g., 0 corresponds to complete disability or responding "extremely" limited, difficult or bothersome to all questions answered), withe a score of 100 corresponds to no disability (e.g., responding "not at all" limited, difficult or bothersome to all questions answered). For Satisfaction questions, a score of 100 corresponds to extreme satisfaction with current treatment.
Number of patients with recurrent AF Catheter ablations Up to 48 months Any subsequent catheter ablations after the initial procedure
Number of patients with recurrent cardioversions for atrial fibrillation Up to 48 months Electrical or chemical cardioversions
Number of patients with Major bleeding Up to 48 months Fall in Hgb of ≥2 g/dL, transfusion of ≥2 units packed red blood cells (PRBC) or whole blood, in a critical location (e.g., intracranial, intraspinal, intraocular, retroperitoneal, intraarticular or pericardial
Trial Locations
- Locations (1)
QEIIHSC
🇨🇦Halifax, Nova Scotia, Canada