Pacemaker Quantified Physical Activity Predicts All-Cause Mortality

Tyagi, Sudhi; Curley, Michael; Berger, Marcie; Fox, Judith; Strath, Scott J.; Rubenstein, Jason; Roth, James A.; Widlansky, Michael E.

doi:10.1016/j.jacc.2015.06.005

Cited by 12 publications

(23 citation statements)

References 5 publications

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“…Investigators in that study reported a higher risk among those in the lowest quartile of moderate (AHR = 1.58, 95% confidence interval: 1.10, 2.27) and light (AHR = 1.57, 95% confidence interval: 1.08, 2.29) activity compared with persons in the highest or most active quartile. These findings are also supported by results from several studies among patients with peripheral arterial disease (12) and chronic heart failure (13,14) and among pacemaker recipients (15). ≥70 years), sex, race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, other), educational level (less than high school, high school graduate/general education development certificate, or more than high school), married (yes vs. no), cigarette smoking (never, former, or current), interaction between current employment and follow-up time, need special equipment to walk (yes vs. no), arthritis (yes vs. no), cancer (no, nonmelanoma skin cancer, or any other type of cancer), body mass index (underweight, normal, overweight, obese class I, or obese class II/III), interaction between body mass index categories and follow-up time, hypertension (no, prehypertension, or yes), and diabetes (no, prediabetes, or yes).…”

Section: Discussionsupporting

confidence: 76%

Associations of Accelerometry-Assessed and Self-Reported Physical Activity and Sedentary Behavior With All-Cause and Cardiovascular Mortality Among US Adults

Evenson¹,

Wen²,

Herring³

2016

American Journal of Epidemiology

119

130

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The US physical activity (PA) recommendations were based primarily on studies in which self-reported data were used. Studies that include accelerometer-assessed PA and sedentary behavior can contribute to these recommendations. In the present study, we explored the associations of PA and sedentary behavior with all-cause and cardiovascular disease (CVD) mortality in a nationally representative sample. Among the 2003-2006 National Health and Nutrition Examination Survey cohort, 3,809 adults 40 years of age or older wore an accelerometer for 1 week and self-reported their PA levels. Mortality data were verified through 2011, with an average of 6.7 years of follow-up. We used Cox proportional hazards models to obtain adjusted hazard ratios and 95% confidence intervals. After excluding the first 2 years, there were 337 deaths (32% or 107 of which were attributable to CVD). Having higher accelerometer-assessed average counts per minute was associated with lower all-cause mortality risk: When compared with the first quartile, the adjusted hazard ratio was 0.37 (95% confidence interval: 0.23, 0.59) for the fourth quartile, 0.39 (95% confidence interval: 0.27, 0.57) for the third quartile, and 0.60 (95% confidence interval: 0.45, 0.80) second quartile. Results were similar for CVD mortality. Lower all-cause and CVD mortality risks were also generally observed for persons with higher accelerometer-assessed moderate and moderate-to-vigorous PA levels and for self-reported moderate-to-vigorous leisure, household and total activities, as well as for meeting PA recommendations. Accelerometer-assessed sedentary behavior was generally not associated with all-cause or CVD mortality in fully adjusted models. These findings support the national PA recommendations to reduce mortality.

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Section: Discussionsupporting

confidence: 76%

Associations of Accelerometry-Assessed and Self-Reported Physical Activity and Sedentary Behavior With All-Cause and Cardiovascular Mortality Among US Adults

Evenson¹,

Wen²,

Herring³

2016

American Journal of Epidemiology

119

130

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“…Twenty‐one studies included only patients with HF, whereas 8 studies included patients with all devices regardless of cardiac pathology. One study specifically focused on patients with pacemakers and preserved left ventricular function . Nearly half of the studies were secondary analyses of clinical trial data (n=12 [41%]).…”

Section: Resultsmentioning

confidence: 99%

“…The association between D‐PA and mortality has been a focus of considerable research. Seven studies examined the relationship between D‐PA and all‐cause mortality, with one including both all‐cause and cardiac mortality . Of these studies, all reported a significant inverse association between D‐PA and all‐cause mortality in unadjusted and adjusted models.…”

Section: Resultsmentioning

confidence: 99%

“…Of these studies, all reported a significant inverse association between D‐PA and all‐cause mortality in unadjusted and adjusted models. One study of patients with pacemakers and preserved left ventricular function showed that all‐cause mortality increased as daily D‐PA decreased and that patients with lower D‐PA at baseline (<1 hour of activity per day) had a 7.4‐fold elevated mortality risk at follow‐up, compared with those who were more active (>3 h/d). Early activity (average activity over the first month after implantation) was also found to be inversely associated with all‐cause mortality and cardiac morality .…”

Section: Resultsmentioning

confidence: 99%

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Measuring Physical Activity With Implanted Cardiac Devices: A Systematic Review

Rosman

Lampert

Sears

et al. 2018

JAHA

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BackgroundPhysical activity is predictive of cardiovascular outcomes in patients with cardiovascular implantable electronic devices, yet it is not regularly assessed in routine care. Current‐generation cardiovascular implantable electronic devices, however, continuously monitor patient activity through a built‐in accelerometer, which provides new opportunities to remotely assess patient activity, detect changes in clinical status, and incorporate these data in risk stratification models. This review critically examines the literature on device‐measured physical activity (D‐PA), with a focus on identifying methodological issues that may affect interpretation of study results.Methods and ResultsWe conducted a systematic review of D‐PA studies published from January 1 1995 to December 30 2017, identifying 29 studies meeting inclusion criteria, 5 of which were validation reports. Few technical details about D‐PA sensors are reported, and procedures for analyzing and interpreting D‐PA data are heterogeneous. Trends in D‐PA over time and associations with clinical outcomes were reported by 22 studies, and in 7 studies, D‐PA was combined with other device parameters in risk stratification models, demonstrating modest‐to‐good sensitivity in predicting acute heart failure decompensation, hospitalization, and mortality.ConclusionsCurrent evidence suggests that D‐PA may be useful for assessing physical activity and predicting clinical outcomes in patients with cardiovascular implantable electronic devices when combined with other device parameters. Future work must address challenges related to D‐PA data measurement, interpretation, and generalizability to support expanded clinical applications of this technology.

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“…Other studies have reported a higher risk of mortality with lower accelerometer-derived physical activity among patients with peripheral arterial disease, 31 chronic heart failure, 32,33 and pacemaker recipients. 34 Using the 2003–2006 NHANES cohort among adults aged ≥ 40 years, higher levels of average physical activity intensity, MVPA, and MVPA bouts as summarized in average duration/day were all associated with a lower risk of all-cause and cardiovascular mortality. 6 Other NHANES studies have also reported on these associations, with some examples referenced.…”

Section: Discussionmentioning

confidence: 99%

Accelerometry-Assessed Latent Class Patterns of Physical Activity and Sedentary Behavior With Mortality

Evenson

Herring²,

Wen

2017

American Journal of Preventive Medicine

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Introduction Latent class analysis provides a method for understanding patterns of physical activity and sedentary behavior. This study explored the association of accelerometer-assessed patterns of physical activity/sedentary behavior with all-cause mortality. Methods The sample included 4,510 U.S. National Health and Nutrition Examination Survey participants aged ≥ 40 years enrolled in 2003–2006 with mortality follow-up through 2011. Participants wore a hip-worn accelerometer for 1 week that provided minute-by-minute information on physical activity/sedentary behavior. Accelerometry patterns were derived using latent class analysis. Cox proportional hazards models provided adjusted hazard ratios with 95% CIs. Analyses were conducted from 2014 to 2016. Results During an average of 6.6 years of follow-up, 513 deaths occurred. For average counts/minute, the more-active classes had a lower risk of mortality compared with the lowest Class 1. Findings were generally similar for percentage of the day in minutes and bouts of moderate to vigorous physical activity, defined two ways. For percentage of the day in sedentary behavior, generally no associations were identified. However, the class with the highest percentage of the day in sedentary bouts (Class 1) had a higher risk of mortality (adjusted hazard ratio, 2.10; 95% CI=1.11, 3.97) versus the class with fewer sedentary bouts (Class 7). Conclusions In this national observational study, time spent in more physical activity reduced the risk of all-cause mortality and time spent in more sedentary bouts increased the risk of all-cause mortality, regardless of how both was accumulated. The latent class analysis contributed to understanding the impact of patterning of physical activity/sedentary behavior on mortality.

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Pacemaker Quantified Physical Activity Predicts All-Cause Mortality

Cited by 12 publications

References 5 publications

Associations of Accelerometry-Assessed and Self-Reported Physical Activity and Sedentary Behavior With All-Cause and Cardiovascular Mortality Among US Adults

Associations of Accelerometry-Assessed and Self-Reported Physical Activity and Sedentary Behavior With All-Cause and Cardiovascular Mortality Among US Adults

Measuring Physical Activity With Implanted Cardiac Devices: A Systematic Review

Accelerometry-Assessed Latent Class Patterns of Physical Activity and Sedentary Behavior With Mortality

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