A Qualitative Investigation of Barriers, Facilitators, and Preferences Regarding a Cardiac Rehabilitation-Based Behavioral Weight Loss Program in Adults with Atrial Fibrillation and Obesity.

Up to one-third of patients with atrial fibrillation (AF) live with obesity and stand to experience improvements in AF symptom burden through moderate weight loss. Cardiac rehabilitation (CR) programs are ideal settings to manage AF risk factors, however few programs offer targeted behavioral weight loss treatment (BWLT). The aim of this study was to investigate perceived barriers and facilitators of participating in BWLT + CR to inform the development of a BWLT for patients with AF and obesity using a qualitative descriptive approach. Purposive sampling was used to recruit patients with AF and BMI ≥ 30 kg/m2 from an AF specialty clinic in Canada. Patients participated in semi-structured interviews regarding perceived barriers, facilitators, and preferences to a proposed BWLT+ CR program consisting of 12 wk of supervised CR exercise with weekly, virtual, group-based BWLT sessions followed by bi-weekly follow up support for 12 wk. Interviews were recorded and transcribed verbatim. Conventional content analysis was used to analyze the qualitative data. Twenty patients (9 women; 100% white) participated in the interviews. Data were categorized to describe barriers (e.g., time constraints), facilitators (e.g., accountability) and preferences (e.g., virtual participation options). Four overarching themes emerged: 1) gender differences in prior weight loss attempts; 2) AF symptoms are manageable; 3) need for more AF patient education; and 4) a desire for flexibility. In conclusion, patients unanimously reported that a BWLT+ CR program was desirable and had few barriers to participating. Results informed modifications to a BWLT+ CR program which is currently being tested in a randomized clinical trial.