Reversal of Atrial Substrate to Prevent Atrial Fibrillation Cohort Study
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 198
- 试验地点
- 7
- 主要终点
- Number of patients with atrial fibrillation (AF) related hospitalizations
研究概览
简要总结
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.
详细描述
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:
- 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.
- 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.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •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 or were not approached for participation in the main study. Eligible patients must have received catheter ablation for AF during the same timeline of the RASTA-AF Mian Study (November 1st, 2019 to December 31st, 2025).
排除标准
- •permanent AF (AF lasting > 3 years),
- •prior catheter ablation for AF
- •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
- •less than 18 years of age
结局指标
主要结局
Number of patients with atrial fibrillation (AF) related hospitalizations
时间窗: Up to 60 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.
Number of patients with atrial fibrillation (AF) related ED visits
时间窗: Up to 60 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
时间窗: Up to 60 months
Clinically significant AF events lasting greater or equal to 24 hours within 26 hours (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.
次要结局
- Number of patients with a composite of AF-related hospitalizations and ED visits or clinically significant AF(Up to 60 months)
- Quality of Life - CCS SAF scale(Up to 60 months)
- Number of patients with stroke or systemic embolism(Up to 60 months)
- Quality of Life - AFEQT(Up to 60 months)
- Quality of Life Health Outcomes using EuroQol-5D-5L(Up to 24 months)
- Number of patients with gender association, Atrial fibrillation risk factors and risk factor management(Up to 24 months)
- Number of patients with recurrent AF Catheter ablations(Up to 60 months)
- Number of patients with recurrent cardioversions for atrial fibrillation(Up to 60 months)
- Number of patients with Major bleeding(Up to 60 months)
- Number of Deaths(Up to 60 months)
研究者
Ratika Parkash
Physician
Nova Scotia Health Authority