Physical Activity Measured With Implanted Devices Predicts Patient Outcome in Chronic Heart Failure

Abstract

Background— Physical activity (PA) predicts cardiovascular mortality in the population at large. Less is known about its prognostic value in patients with chronic heart failure (HF). Methods and Results— Data from 836 patients with implantable cardioverter defibrillator without or with cardiac resynchronization therapy enrolled in the Sensitivity of the InSync Sentry OptiVol feature for the prediction of Heart Failure (SENSE-HF) 1 study and the Diagnostic Outcome Trial in Heart Failure (DOT-HF) were pooled. The devices continuously measured and stored total daily active time (single-axis accelerometer). Early PA (average daily activity over the earliest 30-day study period) was studied as a predictor of time to death or HF-related hospital admission (primary end point). Data from 781 patients were analyzed (65±10 years; 85% men; left ventricular ejection fraction, 26±7%). Older age, shorter height, ischemic cause, peripheral artery disease, atrial fibrillation, diabetes mellitus, rales, peripheral edema, higher New York Heart Association class, lower diastolic blood pressure, and no angiotensin II receptor blocker/angiotensin-converting enzyme inhibitor use were associated with reduced early PA. The primary end point occurred in 135 patients (15±7 months of follow-up). In multivariable analysis including baseline variables, early PA predicted death or HF hospitalization, with a 4% reduction in risk for each 10 minutes per day additional activity (hazard ratio [HR], 0.96; confidence interval [CI], 0.94–0.98; P =0.0002 compared with a model with the same baseline variables but without PA). PA also predicted death (HR, 0.93; CI, 0.90–0.96; P <0.0001) and HF hospitalization (HR, 0.97; CI, 0.95–0.99; P =0.011). Conclusions— Early PA, averaged over a 30-day window early after defibrillator implantation or cardiac resynchronization therapy in patients with chronic HF, predicted death or HF hospitalization, as well as mortality and HF hospitalization separately, accounting for baseline HF severity. Clinical Trial Registration Information— URL: http://www.clinicaltrials.gov . Unique identifiers: NCT00400985, NCT00480077.

Refined heart failure detection algorithm for improved clinical reliability of OptiVol alerts in CRT-D recipients

“…Patient activity measured by cardiac implantable electronic devices were evaluated alone [11][12][13] or together with other diagnostics [5,6] in previous studies. Conraads et al [11] demonstrated that higher levels of physical activity early after defibrillator implantation was associated with better outcomes in terms of mortality and HF hospitalization.…”

“…Conraads et al [11] demonstrated that higher levels of physical activity early after defibrillator implantation was associated with better outcomes in terms of mortality and HF hospitalization. In a single-center study of 164 CRT recipients both 6-min walk test and device-based measures of higher physical activity predicted reverse remodeling and HF hospitalizations [12].…”

Exercise-based cardiac rehabilitation in cardiac resynchronization therapy recipients: A primer for practicing clinicians

“…Early physical activity, averaged over a 30-day window early after CRT implantation, has been recently found to predict death or HF hospitalization [15], but unfortunately no detailed information about the effect of structured ET on major cardiovascular events after CRT is available. The "Exercise Training Following Cardiac Resynchronization Therapy in Patients With Chronic Heart Failure" randomized study [16] is currently evaluating if adding an ET program following CRT may provide better clinical benefits than CRT alone.…”

New Management Strategies in Heart Failure

“…77 The hypothesis has been that such early detection systems might prevent HF admissions and reduce mortality. For many years, ICDs and CRT with and without ICDs have incorporated software that includes HF diagnostic data, such as hemodynamics (pressure or fluid index derived from intrathoracic impedance), correlates of physical activity, 78 or autonomics to predict HF events. 79,80 Some clinicians and trials have found the addition of this information to be helpful in the assessment of patients with HF, but HF clinical practice guidelines have not considered their value highly.…”