Browsing by Author "Wilton, Stephen B."

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    A randomized controlled trial of a “Small Changes” behavioral weight loss treatment delivered in cardiac rehabilitation for patients with atrial fibrillation and obesity: study protocol for the BE-WEL in CR-AF study
    (2024-10-11) Williamson, Tamara M.; Rouleau, Codie R.; Wilton, Stephen B.; Valdarchi, A. B.; Moran, Chelsea; Patel, Stuti; Lutes, Lesley; Aggarwal, Sandeep G.; Arena, Ross; Campbell, Tavis S.
    Abstract Background Atrial fibrillation (AF) represents a global epidemic. Although international AF practice guidelines indicate weight loss for patients with AF and comorbid obesity (BMI ≥ 30 kg/m2) to alleviate symptom burden and improve prognosis, few cardiac rehabilitation (CR) programs include targeted weight loss treatment. Aims This RCT protocol will evaluate the efficacy of a “Small Changes” behavioral weight loss treatment (BWLT) to produce clinically relevant (≥ 10%) weight loss among patients with AF and obesity undergoing CR, relative to CR alone. Secondary aims are to establish efficacy of CR + BWLT for improving AF symptoms, AF risk factors, and health-related quality of life. Methods Adults (18 +) with AF and obesity will be recruited and randomized to receive CR + BWLT (intervention) or CR-only (control). Controls will receive CR consisting of supervised exercise and risk factor self-management for 12 weeks. The intervention group will receive CR plus BWLT (12 weekly, group-based virtual sessions, followed by 12 weeks of follow-up support). Weight and AF-risk factors will be assessed at pre-randomization, 12 weeks, 24 weeks, and 52 weeks. AF burden will be assessed using 30-s ECGs recorded bidaily and with AF symptoms. The primary endpoint of weight loss will be calculated from baseline to 52 weeks as a percentage of starting weight. Intention-to-treat analyses will compare the proportion in each group achieving ≥ 10% weight loss. Assuming success rates of 5% and 30% among controls and intervention groups, respectively, and a 30% loss to follow-up, 120 patients (60 per group) will provide 80% power to detect a difference using a two-sided independent test of proportions (alpha = 5%). Impact This clinical trial will be the first to demonstrate that adding BWLT to CR promotes clinically meaningful weight loss among patients with AF and comorbid obesity. Findings will inform design and execution of a large efficacy trial of long-term (e.g., 5-year) clinical endpoints (e.g., AF severity, mortality). Implementing weight control interventions designed to target the AF substrate in CR could dramatically reduce morbidity and enhance quality of life among patients living with AF in Canada. Trial registration ClinicalTrials.gov registration number: NCT05600829. Registered October 31, 2022.
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    Advanced cardiac imaging analysis in atrial fibrillation and its hemodynamics
    (2023-12-20) Kim, Hansuk; Garcia Flores, Julio; Fear, Elise; Wilton, Stephen B.
    Atrial fibrillation (AF) is a prevalent cardiac disorder characterized by rapid and disorganized atrial activation, resulting in impaired atrial function. With a global impact affecting approximately 33.5 million individuals, AF leads to an elevated risk of complications such as thromboembolism and stroke. Current treatment guidelines primarily rely on patient demographics and medical history, yet a more precise therapeutic approach based on individual flow is required. 4D flow magnetic resonance imaging (MRI) offers comprehensive measurement of flow velocity throughout the entire cardiac cycle in three dimensions. While previous studies have explored the application of 4D flow techniques in AF, they have encountered limitations related to resolution and contrast, particularly when segmenting the fine structures of the left atrium (LA). Furthermore, the clinical parameters derived from 4D flow MRI in AF have been relatively limited, and there has been notable absence of studies focused on assessing flow recovery after catheter ablation. This research addresses the technical and clinical gaps in previous studies, aiming to enhance the clinical applicability of 4D flow imaging techniques in AF. In clinical aspect, our investigation explores the impact of AF on left ventricular (LV) flow in paroxysmal AF using LV flow component analysis. This analysis unveils subtle alterations in LV flow efficiency, even in patients with paroxysmal AF and normal systolic function, indicating hemodynamic changes without signs of adverse LV remodeling. Our comparative study of LA flow in AF patients before and after catheter ablation reveals significant changes in LA blood flow stasis using 4D flow imaging. To overcome the limitations of resolution and contrast of 4D flow, we propose a segmentation method utilizing standard-of-care contrast-enhanced magnetic resonance angiography (CE-MRA) and a registration process with 4D flow data. In conclusion, this thesis advances the application of 4D-flow MRI in AF studies, offering novel insights and clinically relevant findings. These findings pave the way for more precise and individualized therapeutic strategies in the management of AF.
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    APPROACH e-PROM system: a user-centered development and evaluation of an electronic patient-reported outcomes measurement system for management of coronary artery disease
    (2024-08-28) Roberts, Andrew; Benterud, Eleanor; Santana, Maria J.; Engbers, Jordan; Lorenz, Christine; Verdin, Nancy; Pearson, Winnie; Edgar, Peter; Adekanye, Joel; Javaheri, Pantea; MacDonald, Courtney E.; Simmons, Sarah; Zelinsky, Sandra; Caird, Jeff; Sawatzky, Rick; Har, Bryan; Ghali, William A.; Norris, Colleen M.; Graham, Michelle M.; James, Matthew T.; Wilton, Stephen B.; Sajobi, Tolulope T.
    Abstract Background Coronary artery disease (CAD) confers increased risks of premature mortality, non-fatal morbidity, and significant impairment in functional status and health-related quality of life. Routine administration of electronic patient-reported outcome measures (PROMs) and its real time delivery to care providers is known to have the potential to inform routine cardiac care and to improve quality of care and patient outcomes. This study describes a user-centered development and evaluation of the Alberta Provincial Project for Outcomes Assessment (APPROACH) electronic Patient Reported Outcomes Measurement (e-PROM) system. This e-PROM system is an electronic system for the administration of PROMs to patients with CAD and the delivery of the summarized information to their care providers to facilitate patient-physician communication and shared decision-making. This electronic platform was designed to be accessible via web-based and hand-held devices. Heuristic and user acceptance evaluation were conducted with patients and attending care providers. Results The APPROACH e-PROM system was co-developed with patients and care providers, research investigators, informaticians and information technology experts. Five PROMs were selected for inclusion in the online platform after consultations with patient partners, care providers, and PROMs experts: the Seattle Angina Questionnaire, Patient Health Questionnaire, EuroQOL, and Medical Outcomes Study Social Support Survey, and Self-Care of Coronary Heart Disease Inventory. The heuristic evaluation was completed by four design experts who examined the usability of the prototype interfaces. User acceptance testing was completed with 13 patients and 10 cardiologists who evaluated prototype user interfaces of the e-PROM system. Conclusion Both patients and physicians found the APPROACH e-PROM system to be easy to use, understandable, and acceptable. The APPROACH e-PROM system provides a user-informed electronic platform designed to incorporate PROMs into the delivery of individualized cardiac care for persons with CAD.