Impaired chronotropic response to physical activities in heart failure patients

Abstract

BackgroundWhile exercise-based cardiac rehabilitation has a beneficial effect on heart failure hospitalization and mortality, it is limited by the presence of chronotropic incompetence (CI) in some patients. This study explored the feasibility of using wearable devices to assess impaired chronotropic response in heart failure patients.MethodsForty patients with heart failure (left ventricular ejection fraction, LVEF: 44.6 ± 5.8; age: 54.4 ± 11.7) received ECG Holter and accelerometer to monitor heart rate (HR) and physical activities during symptom-limited treadmill exercise testing, 6-min hall walk (6MHW), and 24-h daily living. CI was defined as maximal HR during peak exercise testing failing to reach 70% of age-predicted maximal HR (APMHR, 220 – age). The correlation between HR and physical activities in Holter-accelerometer recording was analyzed.ResultsOf 40 enrolled patients, 26 were able to perform treadmill exercise testing. Based on exercise test reports, 13 (50%) of 26 patients did not achieve at least 70% of APMHR (CI patients). CI patients achieved a lower % APMHR (62.0 ± 6.3%) than non-CI patients who achieved 72.0 ± 1.2% of APMHR (P < 0.0001). When Holter-accelerometer recording was used to assess chronotropic response, the percent APMHR achieved during 6MHW and physical activities was significantly lower in CI patients than in non-CI patients. CI patients had a significantly shorter 6MHW distance and less physical activity intensity than non-CI patients.ConclusionThe study found impaired chronotropic response in 50% of heart failure patients who took treadmill exercise testing. The wearable Holter-accelerometer recording could help to identify impaired chronotropic response to physical activities in heart failure patients.Trial registrationClinicalTrials.gov ID NCT02358603. Registered 16 May 2014.

Depressive symptoms, physical activity, and clinical events: The ADAPT prospective pilot study

“…The present findings add to a growing body of evidence suggesting that lower levels of PA may independently associate with poor transplant clinical outcomes, independent of other psychosocial characteristics. Our findings extend previous work in pulmonary and cardiac samples demonstrating that lower levels of actigraphy‐assessed PA are predictive of poorer clinical outcomes. Our work also extends previous findings among lung transplant recipients by demonstrating that greater post‐transplant depressive symptoms also are associated with worse clinical outcomes, independent of PA.…”

“…Recent case series data suggest that cardiothoracic transplant recipients exhibit lower levels of PA within 1 year of transplantation compared with age‐ and gender‐matched controls and that PA may be improved through intervention . In addition, lower levels of PA have been associated with poorer clinical outcomes in both pulmonary and cardiac patients. Although few studies have examined PA and related factors following transplant, we recently demonstrated that lower functional capacity (eg, six‐minute walk distance [6MWD]) was independently associated with worse clinical outcomes after lung transplantation .…”

Syncopes and clinical outcome in heart failure: results from prospective clinical study data in Germany

“…Autonomic dysfunction (AD) plays a major role in both sudden cardiac death and syncopes as well as in HF . In addition, HF is also associated with chronotropic incompetence (CI) . CI leads to the limitation of physical activity and amplifies the HF symptoms.…”

Precision implementation of early ambulation in elderly patients underwent off-pump coronary artery bypass graft surgery: a randomized controlled clinical trial

“…Previous studies have demonstrated that adverse events (such as decreased SPO 2 , tachycardia and frailty) frequently occur in elderly patients. Referencing exercise physiology, we believed APMHR and VO 2max were novel but valuable to cardiac rehabilitation, primarily with accurate evaluation to physiological responses [26,27]. Shen et al reported that patients whose heart function decreased more than 50% could not tolerate 70% of APMHR exercises [26].…”

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