Wearable Cardioverter–Defibrillator-Measured Step Count for the Surveillance of Physical Fitness during Cardiac Rehabilitation

Abstract

Background: The wearable cardioverter–defibrillator (WCD) has a built-in accelerometer, which allows tracking of patients’ physical activity by remote monitoring. It is unclear whether WCD-measured physical activity, step count, and heart rate correlate with established tools for the assessment of cardiopulmonary fitness such as the 6-min walk test (6MWT). Objective: To correlate measurements of patient physical activity through the WCD with a supervised 6MWT during in-patient cardiac rehabilitation (CR) and to allow their use as surrogate parameters of cardiopulmonary fitness in an out-patient setting. Methods: Consecutive patients with a history of WCD use treated at our center and an in-patient CR following an index hospitalization were included. Baseline characteristics, measurements of WCD accelerometer (median daily step count, median daily activity level), median daily heart rate, and clinically supervised 6MWT at admission and discharge of CR were obtained. Results: Forty-one patients with a mean age of 55.5 (±11.5) years were included. Thirty-five patients (85.4%) were male and 28 patients (68%) had a primary prophylactic WCD-indication. The most common underlying heart diseases were ischemic heart disease (24 patients 58.6%) and dilated cardiomyopathy (13 patients, 31.7%). Median CR duration was 20 (IQR 19.75–26.25) days. 6MWT distance increased from a mean of 329 m (±107) to 470 m (±116) during CR (p < 0.0001). The median daily step count and activity level increased significantly, from 5542 steps (IQR 3718–7055) to 8778 (IQR 6229–12,920, p < 0.0001) and median 117 × 106 (IQR 96 × 106–142 × 106) threshold value exceedance (TVE) to 146 × 106 TVE (IQR 110 × 106–169 × 106, p < 0.0001), respectively. The median heart rate was 74.9 bpm (IQR 65.8–84.5) and 70.2 (IQR 64.1–77.3, p = 0.09) at admission and discharge, respectively. Of all three parameters, median daily step count showed the best correlation to the results of the 6MWT at admission and discharge (r = 0.32, p = 0.04 and 0.37, p = 0.02, respectively). Conclusions: Remote monitoring of median daily step count as assessed by the WCD’s accelerometer showed positive correlation with the 6MWT and could serve as a surrogate for cardiopulmonary exercise capacity. Assessment of daily step count and activity level measured remotely by the WCD could help to tailor optimal exercise instruction for patients not attending CR.

Cardiovascular Rehabilitation With a WCD—Data From the CR3 Study (Cardiac Rehab Retrospective Review)

“…The WCD may serve as a tool for prolonged CR measures in an outpatient setting, as former studies have tested the device to surveil a 6-min walking test. 24,25 Integrated in the WCD, accelerometers can detect not only the step count and the average heart rate, but also the body position during day and night already tested in studies. [26][27][28] Data from an ICD cohort during the COVID-19 pandemic confirmed the need for telemedically controlled home-based exercise training programs.…”

“…The percentage of alarms in general and the distribution into inappropriate alarms is comparable to those in literature. 12,24,[30][31][32] However, the high number of alarms did not seem to reduce wearing compliance that was overall very high.…”

“…The duration of CR was 28 (28, 28) d compared with a total WCD prescription duration of 94 (84, 151) d. The daily wearing duration was 23.4 (22,24) hr. The majority of patients (41, 76%) started the inpatient CR period with a WCD being prescribed a median 43 (55) d before admission and stopped the WCD after the CR period.…”