Jacob P. Kelly
Remote monitoring using implantable devices to measure daily physical activity proved efficacious in identifying patients with HF who were at risk from hospitalization or death.
According to findings published in JACC: Heart Failure, patients with HF who performed 75 minutes of daily physical activity experienced a 1.13-fold greater risk for the composite endpoint of HF hospitalization or death compared with those who did 85 minutes of physical activity (95% CI, 1.12-1.13)
Within the cohort of patients with HF, monitored via an implantable cardioverter defibrillator or a cardiac resynchronization therapy defibrillator (mean age, 76 years; 92% white; 51% with hypertension; 26% with diabetes), 14.1% experienced the composite endpoint at 1 year and 49.6% experienced it at 5 years.
“Patients with HF with low physical activity precipitated by large slope decreases are at significantly higher risk of experiencing impending HF hospitalization or death,” Jacob P. Kelly, MD, MHS, advanced heart failure and transplant cardiology specialist at the Alaska Heart and Vascular Institute, and colleagues wrote. “Our results suggest that repeated measures of physical activity from implantable devices may be able to identify patients with imminent HF hospitalization or death several weeks before clinical decompensation.”
In other findings, a decrease in daily physical activity from approximately 85 to 75 minutes during an 8-week period was associated with a fourfold elevated risk for HF hospitalization or death (HR = 4.02; 95% CI, 3.82-4.22).
“Our results demonstrate that chronic HF patients with implantable devices with low physical activity and/or large decrease in physical activity in a short period of time have significantly higher risk of experiencing an impending HF hospitalization or death,” Kelly told Healio. “Physical activity data from implantable devices may identify higher-risk patients before clinical decompensation. We believe that these decrements in physical activity are a possible signal that can be targeted with a multitude of therapies including cardiac rehabilitation, opportunities to titrate guideline-directed medical therapy for heart failure or consider alternative therapies in the expanding device realm.”
For this study, researchers used data from the Boston Scientific ALTITUDE data set to identify Medicare beneficiaries who had HF and daily physical activity data and underwent ICD or CRT-D implantation. Investigators used a joint model to determine the relationship between HF hospitalization or death and the time-varying point estimate of physical activity and the time-varying slope of physical activity at the 1-year and 5-year follow-up.
“Future work is needed to determine if this signal in reduced physical activity can be used to appropriately interact with patients through prescriptions for cardiac rehabilitation, titrating guideline-directed medical therapy for HF, appropriate device selection or generally motivating patients to become more physically active in hopes of improving outcomes in these patients,” Kelly told Healio. – by Scott Buzby
Disclosures: Kelly reports he received research support from Abbott Medical and Boston Scientific and honoraria from Novartis. Please see the study for all other authors’ relevant financial disclosures.