scholarly journals Sex Differences in Physical Activity and Its Association With Cardiac Death and All-Cause Mortality in Patients With Implantable Cardioverter-Defibrillators

2020 ◽  
Vol 7 ◽  
Author(s):  
Xiaoyao Li ◽  
Xiaodi Xue ◽  
Xuerong Sun ◽  
Shuang Zhao ◽  
Keping Chen ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiac Death ◽  
Hazard Ratio ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Device Implantation ◽  
All Cause Mortality ◽  
Males And Females ◽  
The Impact ◽  
Cardioverter Defibrillators

Objective: To clarify the impact of sex on physical activity (PA) levels among patients with implantable cardioverter-defibrillators/cardiac resynchronization therapy defibrillators (ICD/CRT-D) and its association with cardiac death and all-cause mortality.Methods: Overall, data of 820 patients with ICD/CRT-D from the SUMMIT registry were retrospectively analyzed. Baseline PA from 30 to 60 days after device implantation was measured using Biotronik accelerometer sensors. The primary and secondary endpoints were cardiac death and all-cause mortality, respectively.Results: Baseline PA levels were significantly higher in male patients than in female patients (11.40 ± 5.83% vs. 9.93 ± 5.49%, P = 0.001). Males had higher predictive PA cut-off values for cardiac death (11.16 vs. 7.15%) and all-cause mortality (11.33 vs. 7.17%). During the median follow-up time of 75.7 ± 29.1 months, patients with baseline PA<cut-off values had higher cumulative incidence of cardiac death and all-cause mortality in both males and females. At a PA level between the cut-off values of males and females, males had a higher risk of cardiac death (hazard ratio = 4.952; 95%CI = 1.055-23.245, P = 0.043) and all-cause mortality (hazard ratio = 2.432; 95%CI = 1.095-5.402, P = 0.029).Conclusions: Males had higher predictive PA cut-off values for cardiac death and all-cause mortality in patients with ICD/CRT-D. Sex should be considered as an important contributing factor when deciding for PA targets.

scholarly journals Dose-response association of implantable device-measured physical activity with long-term cardiac death and all-cause mortality in patients at high risk of sudden cardiac death: a cohort study

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Xiaoyao Li ◽  
Shuang Zhao ◽  
Keping Chen ◽  
Wei Hua ◽  
Yangang Su ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
High Risk ◽  
Sudden Cardiac Death ◽  
Dose Response ◽  
Cardiac Death ◽  
Cox Regression ◽  
Cardiac Resynchronization ◽  
All Cause Mortality

Abstract Background Cardiovascular implantable electronic devices (CIEDs) with physical activity (PA) recording function can continuously and automatically collect patients’ long-term PA data. The dose-response association of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRTD)-measured PA with cardiovascular outcomes in patients at high risk of sudden cardiac death (SCD) was investigated. Methods In total, 822 patients fulfilling the inclusion criteria were included and divided into three groups according to baseline PA tertiles: tertile 1 (< 8.04%, n = 274), tertile 2 (8.04–13.24%, n = 274), and tertile 3 (> 13.24%, n = 274). The primary endpoint was cardiac death, the secondary endpoint was all-cause mortality. Results During a mean follow-up of 59.7 ± 22.4 months, cardiac death (18.6% vs 8.8% vs 5.5%, tertiles 1–3, P < 0.001) and all-cause mortality (39.4% vs 20.4% vs 9.9%, tertiles 1–3, P < 0.001) events decreased according to PA tertiles. Compared with patients younger than 60 years old, older patients had a lower average PA level (9.6% vs 12.8%, P < 0.001) but higher rates of cardiac death (13.2% vs 8.1%, P = 0.024) and all-cause mortality (28.4% vs 16.7%, P < 0.001) events. Adjusted multivariate Cox regression analyses showed that a higher tertile of PA was associated with a lower risk of cardiac death (hazard ratio (HR) 0.41, 95% confidence interval (CI): 0.25–0.68, tertile 2 vs tertile 1; HR 0.28, 95% CI: 0.15–0.51, tertile 3 vs tertile 1, Ptrend < 0.001). Similar results were observed for all-cause mortality. The dose-response curve showed an inverse non-linear pattern, and a significant reduction in endpoint risk was observed at the low-moderate PA level. The HR for cardiac death was reduced by half with 12.32% PA (177 min), and the HR for all-cause mortality was reduced by half with 11.92% PA (172 min). Subgroup analysis results indicated that older adults could benefit from PA and the range for achieving optimal benefits might be lower. Conclusions PA monitoring may aid in long-term management of patients at high risk of SCD. More PA will generate better survival benefits, but even low-moderate PA is already good especially for older adults, which is relatively easy to achieve.

scholarly journals Association of changing physical activity intensity and bout length with mortality: a study of 79,507 participants in UK Biobank

2020 ◽  
Author(s):  
Louise Amanda Claire Millard ◽  
Kate Tilling ◽  
Tom R Gaunt ◽  
David Carslake ◽  
Deborah A Lawlor
Keyword(s):  
Physical Activity ◽  
Mortality Risk ◽  
Analytical Approach ◽  
Vigorous Physical Activity ◽  
Hazard Ratio ◽  
Uk Biobank ◽  
Bout Length ◽  
All Cause Mortality ◽  
Light Activity ◽  
The Impact

Background Spending more time active (and less time sedentary) is associated with many health benefits such as improved cardiovascular health and lower risk of all-cause mortality. However, it is unclear whether these associations differ depending on whether time spent sedentary or in moderate-vigorous physical activity (MVPA) is accumulated in long or short bouts. In this study we used a novel analytical approach, that accounts for substitution (i.e. more time in MVPA means spending less time sleeping, in light activity or being sedentary), to examine whether length of sedentary and MVPA bouts associates with all-cause mortality. Methods and findings We used data on 79,507 participants from UK Biobank. We derived the total time participants spent in activity categories - sleep, sedentary, light activity and MVPA - on average per day. We also derived the time spent in sedentary and MVPA bouts of short (1-15 minutes), medium (16-40 minutes) and long (41+ minutes) duration. We used Cox proportion hazards regression to estimate the association of spending 10 minutes more average daily time in one activity or bout length category, coupled with spending 10 minutes less time in another, with all-cause mortality. Those spending more time sedentary had higher mortality risk if this replaced time spent in light activity (hazard ratio 1.02 [95% confidence interval (CI): 1.01, 1.03]), and an even higher risk if this replaced time spent in MVPA (hazard ratio 1.08 [95% CI: 1.06, 1.10]). Those spending more time in MVPA had lower mortality risk, irrespective of whether this replaced time spent sleeping, sedentary or in light activity. We found little evidence to suggest that mortality risk differed depending on the length of sedentary or MVPA bouts. A limitation of our study is that we cannot assume that these results are causal, though we adjusted for key confounders. Conclusions Using our novel analytical approach, we uniquely show that time spent in MVPA is associated with reduced mortality, irrespective of whether it replaces time spent sleeping, sedentary or in light activity. This emphasizes the specific importance of MVPA. We found little evidence to suggest that the impact of MVPA differs depending on whether it is obtained from several short bouts or fewer longer bouts, supporting recent policy changes in some countries. Further studies are needed to investigate causality and explore health outcomes beyond mortality.

scholarly journals Association Between Changes in Physical Activity and New-Onset Atrial Fibrillation After ICD/CRT-D Implantation

2021 ◽  
Vol 8 ◽  
Author(s):  
Xuerong Sun ◽  
Shuang Zhao ◽  
Keping Chen ◽  
Wei Hua ◽  
Yangang Su ◽  
...  
Keyword(s):  
Physical Activity ◽  
Atrial Fibrillation ◽  
Cardiac Death ◽  
High Rate ◽  
Cardiac Resynchronization ◽  
All Cause Mortality ◽  
Baseline Status ◽  
Onset Atrial Fibrillation ◽  
New Onset

Background: Changes in physical activity (PA) after implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillators (CRT-D) implantation were unknown. The association of PA changes with new-onset atrial fibrillation (AF), cardiac death and all-cause mortality was unclear in patients at high risk of sudden cardiac death.Methods: Patients receiving ICD/CRT-D implantation from SUMMIT registry were retrospectively analyzed. Changes in PA were considered from baseline status to 1 year after implantation. New-onset AF was defined as the first atrial high-rate episode ≥1% of the daily AF burden detected after implantation.Results: Over a mean follow-up of 50.3 months, 124 new-onset AF events (36.2%), 61 cardiac deaths (17.8%), and 87 all-cause deaths (25.4%) were observed in 343 patients with ICD/CRT-D implantation. PA at 1 year after implantation was increased compared with PA at baseline (11.97 ± 5.83% vs. 10.82 ± 5.43%, P = 0.008), and PA at 1 year was improved in 210 patients (61.2%). Per 1% decrease in PA was associated with 12.4, 18.3, and 14.3% higher risks of new-onset AF, cardiac death and all-cause mortality, regardless of different baseline characteristics. Patients with decreased PA had 2-fold risks of new-onset AF (hazard ratio [HR] = 1.972, 95% confidence interval [CI]: 1.352–2.877, P &lt; 0.001) as high as those with unchanged/increased PA. Decreased PA was an independent risk factor for cardiac death (HR = 3.358, 95% CI: 1.880–5.996, P &lt; 0.001) and all-cause mortality (HR = 2.803, 95% CI:1.732–4.535, P &lt; 0.001).Conclusion: PA decrease after ICD/CRT-D implantation is associated with a higher incidence of new-onset AF, resulting in worsened outcomes in cardiac death and all-cause mortality.

scholarly journals Early Increased Physical Activity, Cardiac Rehabilitation, and Survival After Implantable Cardioverter-Defibrillator Implantation

2021 ◽  
Author(s):  
Brett D. Atwater ◽  
Zhen Li ◽  
Jessica Pritchard ◽  
Melissa A. Greiner ◽  
Yelena Nabutovsky ◽  
...  
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Propensity Scores ◽  
Time Frame ◽  
Hazard Ratio ◽  
Implantable Cardioverter Defibrillators ◽  
Medicare Beneficiaries ◽  
Icd Implantation ◽  
All Cause Mortality

Background: Increased physical activity (PA) through cardiac rehabilitation (CR) improves outcomes in patients with heart failure and coronary disease, but CR referral remains infrequent. Implantable cardioverter-defibrillators (ICDs) can provide daily PA measurements to patients that may motivate them to increase PA, but it remains unclear if increased ICD measured PA is associated with improved outcomes with and without CR. Methods: This is a retrospective observational study of 41 731 Medicare beneficiaries with ICD implantation between January 1, 2014 and December 31, 2016. We linked daily ICD PA measurements and Medicare claims data to determine if increased PA is associated with a reduction in the likelihood of death or heart failure hospitalization. To determine if CR participation altered the effect of PA on outcomes, we performed two additional analyses matching CR participants and nonparticipants using propensity scores. The first match included demographics, comorbidities, and baseline PA measurements. The second match also included the change in PA measured during CR or the same time frame after ICD implant among nonparticipants. Results: The mean age was 75 (SD, 10) years, 30 182 beneficiaries (72.3%) were male, and 1324 (3%) participated in CR. Increased ICD detected PA was associated with improved survival. CR participants had a mean PA change of +9.7 (SD, 57.8) min/d, whereas nonparticipants had a mean change of −1.0 (SD, 59.7) min/d ( P <0.001). After matching for demographics, comorbidities and baseline PA, CR participants had significantly lower 1- to 3-year mortality (hazard ratio, 0.76 [95% CI, 0.69–0.85], P =0.03). After additionally matching for the ICD measured change in PA during CR there were no differences in mortality with and without CR (hazard ratio, 1.00 [95% CI, 0.82–1.21], P =0.87). Every 10 minutes of increased daily PA was associated with a 1.1% reduction in all-cause mortality in both groups. Conclusions: Among Medicare beneficiaries with ICDs, small increases in PA were associated with significant reductions in all-cause mortality.

Clinical Heart Failure Among Patients With and Without Severe Mental Illness and the Association With Long-Term Outcomes

2021 ◽  
Author(s):  
Christoffer Polcwiartek ◽  
Daniel Loewenstein ◽  
Daniel J. Friedman ◽  
Karin G. Johansson ◽  
Claus Graff ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Hazard Ratio ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Assist Device ◽  
Ventricular Assist ◽  
Device Implantation ◽  
Left Ventricular Assist ◽  
All Cause Mortality

Background: Patients with severe mental illness (SMI) including schizophrenia, bipolar disorder, and severe depression have earlier onset of cardiovascular risk factors, predisposing to worse future heart failure (HF) compared with the general population. We investigated associations between the presence/absence of SMI and long-term HF outcomes. Methods: We identified patients with HF with and without SMI in the Duke University Health System from 2002 to 2017. Using multivariable Cox regression, we examined the primary outcome of all-cause mortality. Secondary outcomes included rates of implantable cardioverter defibrillator use, cardiac resynchronization therapy, left ventricular assist device implantation, and heart transplantation. Results: We included 20 906 patients with HF (SMI, n=898; non-SMI, n=20 008). Patients with SMI presented clinically 7 years earlier than those without SMI. We observed an interaction between SMI and sex on all-cause mortality ( P =0.002). Excess mortality was observed among men with SMI compared with men without SMI (hazard ratio, 1.36 [95% CI, 1.17–1.59]). No association was observed among women with and without SMI (hazard ratio, 0.97 [95% CI, 0.84–1.12]). Rates of implantable cardioverter defibrillator use, cardiac resynchronization therapy, left ventricular assist device implantation, and heart transplantation were similar between patients with and without SMI (6.1% versus 7.9%, P =0.095). Patients with SMI receiving these procedures for HF experienced poorer prognosis than those without SMI (hazard ratio, 2.12 [95% CI, 1.08–4.15]). Conclusions: SMI was associated with adverse HF outcome among men and not women. Despite equal access to procedures for HF between patients with and without SMI, those with SMI experienced excess postprocedural mortality. Our data highlight concurrent sex- and mental health-related disparities in HF prognosis, suggesting that patients with SMI, especially men, merit closer follow-up.

The role of implantable cardioverter-defibrillators and sudden cardiac death prevention: indications, device selection, and outcome

2019 ◽  
Vol 41 (21) ◽  
pp. 2003-2011 ◽  
Author(s):  
Ilan Goldenberg ◽  
David T Huang ◽  
Jens Cosedis Nielsen
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Current Knowledge ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Implantable Cardioverter Defibrillators ◽  
Icd Implantation ◽  
Device Selection ◽  
Cardioverter Defibrillators

Abstract Multiple randomized multicentre clinical trials have established the role of the implantable cardioverter-defibrillator (ICD) as the mainstay in the treatment of ventricular tachyarrhythmias and sudden cardiac death (SCD) prevention. These trials have focused mainly on heart failure patients with advanced left ventricular dysfunction and were mostly conducted two decades ago, whereas a more recent trial has provided conflicting results. Therefore, much remains to be determined on how best to balance the identification of patients at high risk of SCD together with who would benefit most from ICD implantation in a contemporary setting. Implantable cardioverter-defibrillators have also evolved from the simple, defibrillation-only devices implanted surgically to more advanced technologies of multi-chamber devices, with physiologic bradycardic pacing, including cardiac resynchronization therapy, atrial and ventricular therapeutic pacing algorithms, and subcutaneous ICDs. These multiple options necessitate individualized approach to device selection and programming. This review will focus on the current knowledge on selection of patients for ICD treatment, device selection and programming, and future directions of implantable device therapy for SCD prevention.

Association of the Obesity Paradox With Objective Physical Activity in Patients at High Risk of Sudden Cardiac Death

2020 ◽  
Vol 105 (12) ◽  
pp. e4801-e4810
Author(s):  
Xiaoyao Li ◽  
Keping Chen ◽  
Wei Hua ◽  
Yangang Su ◽  
Jiefu Yang ◽  
...  
Keyword(s):  
Physical Activity ◽  
High Risk ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Electronic Device ◽  
Home Monitoring ◽  
Obesity Paradox ◽  
Overweight And Obesity ◽  
Cardiac Resynchronization ◽  
All Cause Mortality

Abstract Objective To investigate the obesity paradox and its interrelationship with objective physical activity (PA) in patients at high risk of sudden cardiac death. Methods A total of 782 patients with implantable cardioverter-defibrillators/cardiac resynchronization therapy defibrillators in the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Device-Implantable Patients registry were retrospectively analyzed and grouped by body mass index (BMI) (kg/m2): normal weight (18.5 ≤ BMI &lt; 25) and overweight or class I obesity (25 ≤ BMI &lt; 35). PA was measured with home monitoring and categorized into 4 groups (Q1-Q4) by the baseline quartiles. The main endpoint was all-cause mortality. Results During a mean follow-up period of 59.9 ± 21.9 months, 182 all-cause mortality events occurred. Mortality tended to be lower in overweight and obesity patients (18.9% vs 25.1%, P = 0.061) and decreased by PA quartiles (44.1% vs 22.6% vs 15.3% vs 11.2%, Q1-Q4, P &lt; 0.001). Multivariate Cox analysis indicated BMI (hazard ratio, 0.918; 95% confidence interval, 0.866-0.974; P = 0.004) and PA (0.436, 0.301-0.631, Q2 vs Q1; 0.280, 0.181-0.431, Q3 vs Q1; 0.257, 0.158-0.419, Q4 vs Q1; P &lt; 0.001 for all) were associated with reduced risk. The obesity paradox was significant in the total cohort (log rank P = 0.049) and low PA group (log rank P = 0.010), but disappeared in the high PA group (log rank P = 0.692). Dose-response curves showed a significant reduction in risk with low-moderate PA, and the pattern varied between different BMI groups. Conclusions The obesity paradox only persisted in physically inactive patients. PA might be related to the development of the obesity paradox.

scholarly journals Remote Monitoring of Heart Failure in Patients with Implantable Cardioverter-Defibrillators: Current Status and Future Needs

Sensors ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. 3763
Author(s):  
Dominic A. M. J. Theuns ◽  
Sumant P. Radhoe ◽  
Jasper J. Brugts
Keyword(s):  
Heart Failure ◽  
Remote Monitoring ◽  
Point Of View ◽  
Cardiac Resynchronization ◽  
Current Status ◽  
Ambulatory Setting ◽  
Implantable Cardioverter Defibrillators ◽  
Frequent Monitoring ◽  
The Impact ◽  
Cardioverter Defibrillators

The management of heart failure remains challenging despite evidence-based medical and pharmacological advances, especially in the ambulatory setting. There is an urgent need to develop strategies to reduce hospitalizations and readmission rates due to heart failure. Frequent monitoring of high-risk patients is imperative, and with the development of wireless and remote technology, frequent monitoring is now possible via remote monitoring. Nowadays, remote management of patients with cardiac implantable electronic devices is being increasingly adopted and integrated into clinical practice. Several clinical trials studied the impact of remote monitoring on clinical outcomes in patients with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization defibrillators (CRT-Ds). This point of view will focus on the remote monitoring of ICDs and CRT-Ds in patients with heart failure and discusses whether remote monitoring can be used as a potential instrument for the early identification of patients at risk of worsening heart failure.

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