Dose-response association of implantable device-measured physical activity with long-term cardiac death and all-cause mortality in patients at high risk of ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2020-09-21

AUTHORS

Xiaoyao Li, Shuang Zhao, Keping Chen, Wei Hua, Yangang Su, Jiefu Yang, Zhaoguang Liang, Wei Xu, Shu Zhang

ABSTRACT

BackgroundCardiovascular 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.MethodsIn 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.ResultsDuring 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.ConclusionsPA 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. More... »

PAGES

119

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12966-020-01026-2

DOI

http://dx.doi.org/10.1186/s12966-020-01026-2

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1131074499

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/32957993


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65 highest tertile
66 hr
67 implantable electronic devices
68 inclusion criteria
69 levels
70 long-term cardiac death
71 long-term management
72 lower risk
73 management
74 monitoring
75 months
76 more PA
77 mortality
78 multivariate Cox regression analysis
79 non-linear patterns
80 older adults
81 older patients
82 optimal benefit
83 outcomes
84 patients
85 patterns
86 physical activity
87 primary endpoint
88 range
89 rate
90 recording function
91 reduction
92 regression analysis
93 results
94 risk
95 secondary endpoints
96 significant reduction
97 similar results
98 study
99 subgroup analysis results
100 sudden cardiac death
101 survival benefit
102 tertile
103 tertiles 1
104 total
105 years
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