Lockdown measures for COVID-19 outbreak and variation in physical activity in patients with heart failure and cardiac implantable devices

Cunha, Pedro Silva; Laranjo, Sérgio; Lourenço, André; Rodrigues, Lourenço; Cardoso, I; Portugal, Guilherme; Valente, Bruno; Delgado, Ana Sofia; Ferreira, Rui Cruz; Abreu, Ana; Oliveira, Mário

doi:10.1016/j.ijcha.2021.100906

Cited by 9 publications

(8 citation statements)

References 30 publications

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“…These findings are partially in agreement with those reported by Cunha et al [ 11 ], showing difficult PA recovery in patients with low basal PA; however, they used a shorter study period and did not consider PA reduction during lockdown as a possible predictor of PA recovery failure.…”

Section: Discussionsupporting

confidence: 92%

“…For these reasons, the reduction of PA during the lockdown could have been deleterious, in particular for patients with HF. It has been shown that a large portion of patients (49%) could fail to recover their usual PA after the lockdown period [ 11 ], and the frailty status of older patients could worsen because of stopping their cardiac rehabilitation [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Physical Activity in Patients With Heart Failure During and After COVID-19 Lockdown: Single-Center Observational Retrospective Study

Brasca¹,

Casale²,

Canevese³

et al. 2022

JMIR Cardio

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Background The COVID-19 pandemic forced several European governments to impose severe lockdown measures. The reduction of physical activity during the lockdown could have been deleterious. Objective The aim of this observational, retrospective study was to investigate the effect of the lockdown strategy on the physical activity burden and subsequent reassessment in a group of patients with heart failure who were followed by means of remote monitoring. Methods We analyzed remote monitoring transmissions during the 3-month period immediately preceding the lockdown, 69 days of lockdown, and 3-month period after the first lockdown in a cohort of patients with heart failure from a general hospital in Lombardy, Italy. We compared variation of daily physical activity measured by cardiac implantable electrical devices with clinical variables collected in a hospital database. Results We enrolled 41 patients with heart failure that sent 176 transmissions. Physical activity decreased during the lockdown period (mean 3.4, SD 1.9 vs mean 2.9, SD 1.8 hours/day; P<.001) but no significant difference was found when comparing the period preceding and following the lockdown (–0.0007 hours/day; P=.99). We found a significant correlation between physical activity reduction during and after the lockdown (R2=0.45, P<.001). The only significant predictor of exercise variation in the postlockdown period was the lockdown to prelockdown physical activity ratio. Conclusions An excessive reduction of exercise in patients with heart failure decreased the tolerance to exercise, especially in patients with more comorbidities. Remote monitoring demonstrated exercise reduction, suggesting its potential utility to encourage patients to maintain their usual physical activity levels.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Physical Activity in Patients With Heart Failure During and After COVID-19 Lockdown: Single-Center Observational Retrospective Study

Brasca¹,

Casale²,

Canevese³

et al. 2022

JMIR Cardio

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“…This study has proved that remote monitoring can greatly reduce the arrival time of patients after ICD events. Some large-scale clinical trials abroad have also confirmed this result [ 30 , 31 ]. Some studies found that for patients who were routinely followed up at the hospital every quarter, inappropriate discharge events in ICD occur 64 days earlier than the next follow-up and remote monitoring could detect these inappropriate discharge events in time, which provided sufficient reaction time for doctors [ 32 ].…”

Section: Discussionmentioning

confidence: 55%

Effect of ICD/CRT-D Implantation on Adverse Events and Readmission Rate in Patients with Chronic Heart Failure (CHF)

Liu

Xing

2022

Computational and Mathematical Methods in Medicine

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Objective. To explore the effect of implantable cardioverter defibrillator/cardiac resynchronization therapy defibrillator (ICD/CRT-D) implantation on adverse events and the readmission rate in patients with chronic heart failure (CHF). Methods. Sixty patients with CHF treated in our hospital from April 2019 to July 2021 were enrolled. The patients were randomly assigned into the control group and study group. The control group received routine intervention, and the study group received remote management with ICD/CRT-D implantation. Results. First of all, we compared the general data of the two groups. There was no significant difference in LVEF, NYHA grade, concomitant disease, and history of arrhythmia ( P > 0.05 ). Secondly, we compared the end-point events. In the study group, 5 cases of heart failure were readmitted, 0 cases died, and 4 cases were admitted to hospital with arrhythmia and ICD events, with a total incidence of 30.0%, while in the control group, 12 cases were rehospitalized with heart failure, 3 cases died, 25 cases were admitted with arrhythmia and ICD events, and the total incidence rate was 56.67% ( P < 0.05 ). In terms of the readmission rate of patients with heart failure in grade NYHAII and grade III, among the patients with grade NYHAII, the number of patients with heart failure less than once in the study group was higher compared to that in the control group and the number of patients with heart failure ≥ once in the study group was lower compared to that in the control group ( P < 0.05 ). Among the patients with grade NYHAIII, the number of patients with heart failure less than once in the study group was higher compared to that in the control group and the number of patients with heart failure ≥ once in the study group was lower compared to that in the control group. There exhibited no significant difference in the data ( P > 0.05 ). Considering the occurrence of VT and VF events, the study team reported that 14 patients recorded a total of 276 ventricular arrhythmias: 261 ventricular tachycardia and 15 ventricular fibrillations. Among them, 24 VT (9.2%) and 4 VF (26.7%) were determined to be misrecognition of the equipment. A total of 178 ventricular arrhythmias were recorded in 13 patients in the control group, including 152 ventricular tachycardia and 26 ventricular fibrillations. Among them, 10 VT (6.6%) and 8 VF (30.8%) were determined as misrecognition of the device. In regard to the treatment results of the two groups, after admission to the hospital for radio frequency, ablation, and adjustment of drug treatment to reprogram control, the patients did not reappear to have CRT-D misidentification and misdischarged. Finally, we compared the diagnosis time of VT/VE events. The time from VT/VE events to diagnosis in 14 patients in the study group was 2.55 ± 1.41 days, and that in 13 patients in the control group was 37.32 ± 15.31 days. The discovery of ICD events in the study group was significantly earlier compared to that in the routine follow-up group ( P < 0.05 ). This gives doctors enough time to assess the patient’s condition and determine a further diagnosis and treatment plan. Conclusion. Using ICD/CRT-D implantation to remotely monitor patients with CHF, through remote monitoring of the 24-hour average heart rate and the heart rate at rest and patient activity and other parameters and early intervention, the readmission rate caused by the deterioration of heart failure can be reduced. Compared with routine follow-up, remote monitoring significantly reduced the diagnosis time of VT/VE events.

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“… 6 Male and female patients across all ages exhibited significant declines in PA, with older patients (>80 yr) demonstrating diminished ability to return to pre-pandemic levels. 6 Cunha et al 7 examined changes in PA profiles among US CIED patients with congestive heart failure over three periods: baseline, lockdown, and post-lockdown. These authors divided patients into four distinct groups based on pre-lockdown levels of PA. All patients demonstrated a statistically significant decrease in time spent engaging in PA with an approximate overall decline of 39 min/d compared with pre-lockdown.…”

Section: Resultsmentioning

confidence: 99%

“Unlocking Physical Activity” During COVID-19 in Cardiac Device Patients

Harrell

Anthony

Travia

et al. 2022

Journal of Cardiopulmonary Rehabilitation and Prevention

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Lockdown measures for COVID-19 outbreak and variation in physical activity in patients with heart failure and cardiac implantable devices

Cited by 9 publications

References 30 publications

Physical Activity in Patients With Heart Failure During and After COVID-19 Lockdown: Single-Center Observational Retrospective Study

Physical Activity in Patients With Heart Failure During and After COVID-19 Lockdown: Single-Center Observational Retrospective Study

Effect of ICD/CRT-D Implantation on Adverse Events and Readmission Rate in Patients with Chronic Heart Failure (CHF)

“Unlocking Physical Activity” During COVID-19 in Cardiac Device Patients

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