About the Project
Background.
Atrial fibrillation (AF) is growing in prevalence, overall burden, and AF-associated mortality. The primary aims of treatment are stroke prevention, symptom management, and prevention/management of cardiovascular comorbidities. Ablation procedures are used to treat paroxysmal AF, yet up to 40% of patients develop symptomatic AF 8-12 weeks post-ablation. There is not only a need to improve clinical outcomes, but more of a focus on patient quality of life and mental health is critical. For example, our previous Patient and Public Involvement work has demonstrated that AF patients are primarily concerned with improving their mental health and reducing AF burden.
Physical activity has been shown to reduce AF recurrence, increase fitness, and improve quality of life in patients with AF. Yet, AF rehabilitation is not part of routine care. Although cardiac rehabilitation is effective for improving quality of life and preventing secondary cardiovascular events following acute coronary syndrome, it is not available for AF patients. In addition, patient adherence and long-term behaviour change is often poor and underappreciated. Therefore, co-creating a feasible behaviour change intervention that supports AF patients to become more physically active for the long-term is of great patient and NHS benefit.
Aims and objectives.
The aim of the proposed project is to co-create, test the feasibility, and evaluate the efficacy of an AF rehabilitation intervention (involving physical activity behaviour change) for adults with AF undergoing catheter ablation.
Proposed Methods.
Year 1. First, you will conduct a systematic review to identify promising physical activity intervention components for patients with AF. Second, you will facilitate workshops involving multidisciplinary stakeholders (healthcare policy makers, clinicians, researchers, patients and their family/carers) to co-create a physical activity behaviour change intervention that is deemed feasible to implement into usual AF care.
Year 2. Evaluate the feasibility of the co-created physical activity intervention embedded within AF care compared to usual care.This will involve exploring staff and patient acceptability, patient uptake, adherence, fidelity, and acceptability of measures (e.g. AF burden, mental health, quality of life, physical activity etc.).
Year 3. Using findings from the previous feasibility trial, you will adapt the AF rehabilitation intervention, and evaluate the efficacy of the intervention on patient physical and mental health outcomes via a randomised controlled trial.
Anticipated impact and dissemination.
This multidisciplinary PhD will provide the successful candidate with a diverse experience of co-creation, behaviour change theory, cardiovascular medicine, and exercise physiology. They will be exposed to working both in the university laboratories and in clinical settings. Further, they will be trained in collecting several types of outcome measures including interviews and focus groups, questionnaires, physical activity levels, and cardiovascular measures such as blood pressure, phlebotomy, and ECGs.
Findings from this PhD will be disseminated locally to council and clinical commissioning groups and hospital trust boards. You will also disseminate the work internationally through high-impact, peer-reviewed publications and conference presentations. Finally, there will be opportunity to apply for a subsequent postdoctoral position.
It is expected the successful applicant (s) must commence on or before 1st February 2021.
For any enquiries please contact Dr Benjamin Buckley - [Email Address Removed]
If you wish to apply, please send a covering letter, full CV together with names and contact details of two academic referees, stating the research proposal/s of interest to you and why you think you are suitable. Please send to Dr B Buckley on [Email Address Removed] and Professor Lip on [Email Address Removed].
Funding Notes
The studentships will be for 4 years full-time (subject to satisfactory progress) and will cover the cost of tuition fees at Home/EU rates. A stipend in line with the UK Research Council is payable at £15285 per annum, and an additional allowance of up to £1000 per year will be paid for approved research costs. Please note that funding is only available for the first 3 years but a 4th year is unfunded for writing up. Due to funding restrictions, the studentships are open to Home/EU applicants only.
References
1.Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837-47.
2.Lane DA, Skjoth F, Lip GYH, Larsen TB, Kotecha D. Temporal Trends in Incidence, Prevalence, and Mortality of Atrial Fibrillation in Primary Care. J Am Heart Assoc. 2017;6(5).
3.Wolowacz SE, Samuel M, Brennan VK, Jasso-Mosqueda JG, Van Gelder IC. The cost of illness of atrial fibrillation: a systematic review of the recent literature. Europace. 2011;13(10):1375-85.
4.Wood KA, Barnes AH, Paul S, Hines KA, Jackson KP. Symptom challenges after atrial fibrillation ablation. Hear Lung J Acute Critical Care. 2017;46(6):425-31.
5.Blair SN, Morris JN. Healthy hearts--and the universal benefits of being physically active: physical activity and health. Annals of epidemiology. 2009;19(4):253-6.
6.Chekroud SR, Gueorguieva R, Zheutlin AB, Paulus M, Krumholz HM, Krystal JH, et al. Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: a cross-sectional study. The Lancet Psychiatry. 2018;5.
7.Farrell L, Hollingsworth B, Propper C, Shields MA. The socioeconomic gradient in physical inactivity: evidence from one million adults in England. Soc Sci Med. 2014;123:55-63.
8.Church TS, Blair SN. When will we treat physical activity as a legitimate medical therapy…even though it does not come in a pill? British Journal of Sports Medicine. 2009;43(2):80-1.
9.Pathak RK, Elliott A, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, et al. Impact of CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation: The CARDIO-FIT Study. J Am Coll Cardiol. 2015;66(9):985-96.
10.Pathak RK, Middeldorp ME, Lau DH, Mehta AB, Mahajan R, Twomey D, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. J Am Coll Cardiol. 2014;64(21):2222-31.
11.Kato M, Kubo A, Nihei F, Ogano M, Takagi H. Effects of exercise training on exercise capacity, cardiac function, BMI, and quality of life in patients with atrial fibrillation: a meta-analysis of randomized-controlled trials. Int J Rehabil Res. 2017;40(3):193-201.
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