Alcohol abstinence reduces arrhythmia recurrences, BP in moderate drinkers with AF
NEW ORLEANS — Lowering the consumption of alcohol intake in moderate drinkers with a history of atrial fibrillation may help lower BP and arrhythmia occurrences, according to findings presented at the American College of Cardiology Scientific Session.
Aleksandr Voskoboinik, MBBS, a cardiologist at Alfred Health, the Baker Heart and Diabetes Research Institute, and Royal Melbourne Hospital in Australia, and colleagues sought to identify the effect of alcohol abstinence in moderate drinkers with AF.
Voskoboinik and colleagues analyzed data from a multicenter, randomized controlled trial consisting of patients from six hospital sites.
Adults with paroxysmal or persistent AF and sinus rhythm at baseline who had an average of 10 or more standard drinks per week were assigned 1:1 to abstinence or usual consumption, the researchers wrote.
The primary endpoints at 6 months were freedom from AF recurrence and AF burden, defined as percentage of time in AF, as measured by loop recorders or existing pacemakers (36%) or twice-daily ECGs through an app (Alivecor) in conjunction with Holter monitors (64%). The researchers analyzed patients on an intention-to-treat basis after a 2-week blanking period.
“It was an incredibly challenging study to run,” Voskoboinik said during the presentation. “We had to shorten follow-up from 12 months to 6 months to get patients into the study. There would have been 500 patients who would have been perfect for the study who were not keen to participate because they didn’t want to abstain, so we were left with this motivated group of patients.”
Voskoboinik and colleagues randomly assigned 140 patients (mean age, 62 years; 63% with paroxysmal AF; intake, 17 standard drinks per week) into abstinence and control groups.
Sixty of the 70 patients (86%) in the abstinence arm reduced alcohol intake by 70% or more, according to the researchers, and 84% had negative urine alcohol metabolites. Recurrent AF rate was lower in the abstinence group compared with the control arm (53% vs. 73%; P = .014).
The researchers also found the abstinence arm had longer AF-free survival (P = .004) and lower AF burden (median burden, 0.5% vs. 1.2%; P = .02).
The abstinence arm had a greater reduction in weight (–2.7 kg vs. 0.8 kg; P < .01) and systolic BP (–12.4 mm Hg vs. –1 mm Hg; P = .02), although only abstinence predicted lower AF recurrence (multivariate HR = 0.52; 95% CI, 0.3-0.89), Voskoboinik and colleagues found.
Getting patients to completely abstain from alcohol in the study was difficult, as 60% of patients in the abstinence group were compliant, Voskoboinik said.
“It’s the challenge with all lifestyle measures, in particular, alcohol,” Voskoboinik said. “The message is for us, the clinicians, is to take alcohol history and have that discussion with the patient and look at some data potentially to show them, and again as the end of the day, it’s up to the patient as well in conjunction with the physician.” – by Earl Holland Jr.
Voskoboinik A, et al. Featured Clinical Research III. Presented at: American College of Cardiology Scientific Session; March 16-18, 2019; New Orleans.
Disclosure: Voskoboinik reports no relevant financial disclosures.