Physical activity tied lower all-cause mortality after ICD implantation

Reuters Health - 22/07/2021 - Older patients with implanted cardioverter defibrillators (ICDs) are at lower risk of heart failure hospitalization and all-cause mortality when they get more physical activity, a U.S. study suggests.

Researchers examined data on 41,731 Medicare beneficiaries with ICDs implanted between 2014 and 2016, and more than 31 million remote transmissions of physical activity data from sensors in the ICDs that tracked movement and heart rate. At baseline, patients' mean physical activity totaled 128.9 minutes per day, defined as any amount of movement that was also associated with heart rate values higher than the patient's individualized values at rest.

After three years of follow-up, 51.7% of patients experienced a heart failure hospitalization and 25.1% died, according to Medicare claims data.

Each additional 10 minutes of daily physical activity was associated with 1.1% lower all-cause mortality regardless of whether patients participated in cardiac rehabilitation.

"This finding shows that any small amount of additional physical activity, whether it is walking to the mailbox, cleaning the house, or going shopping may result in a longer life and reduced likelihood of hospitalization in patients with heart failure," said lead study author Dr. Brett Atwater, director of electrophysiology at Inova Heart and Vascular Institute in Falls Church, Virginia.

Traditionally, clinicians have asked patients to exercise at least 30 minutes per day several times a week to reduce their likelihood of developing cardiovascular disease, Dr. Atwater said by email. For some patients who find this amount of movement overwhelming, cardiac rehabilitation may help if they can access and afford this type of resource, Dr. Atwater added.

In the study population, only 1,324 (3.2%) patients participated in cardiac rehabilitation, and these individuals had a mean increase of 9.7 minutes a day of physical activity, data from ICDs showed. By comparison, the majority who didn't do cardiac rehabilitation experienced a mean decrease of 1.1 minutes a day in physical activity.

Cardiac rehabilitation was associated with significantly lower all-cause mortality at three years (hazard ratio 0.76), researchers report in Circulation: Cardiovascular Quality and Outcomes.

However, even when patients who might need cardiac rehabilitation don't do it, the study findings suggest that clinicians should still stress the importance of getting even small amounts of moment as patients go about their daily routines, Dr. Atwater said.

"Even small increases in physical activity, performed outside of a rehab program can meaningfully improve survival," Dr. Atwater said.

One limitation of the study is that all the patients had previously-implanted ICDs, and it's possible that outcomes would be different in a treatment-naive population, the study team notes. It's also possible that results from this study of Medicare enrollees might not be generalizable to patients under 65 years old.

"However, these data clearly demonstrate that it does not take huge amounts of exercise to see improvements in outcomes," said Dr. Todd Brown, an associate professor of medicine in the division of cardiovascular disease at the University of Alabama in Birmingham.

"Perhaps our message to patients should not be focused on exercise regimens per se, but avoidance of a sedentary lifestyle," Dr. Brown, who wasn't involved in the study, said by email. "This may be a less intimidating and more successful message."

SOURCE: https://bit.ly/3zqH6rf Circulation: Cardiovascular Quality and Outcomes, online July 21, 2021.

By Lisa Rapaport



Posted on 22 July 202127 July 2021