Physical Activity Measured With Implanted Devices Predicts Patient Outcome in Chronic Heart Failure
Physical Activity Measured With Implanted Devices Predicts Patient Outcome in Chronic Heart Failure
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DOI：
10.1161/circheartfailure.113.000883
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发表时间：
2014-03-01
影响因子：
9.7
通讯作者：
van Veldhuisen, Dirk J.
中科院分区：
文献类型：
--
作者：
Conraads, Viviane M.;Spruit, Martijn A.;van Veldhuisen, Dirk J.
背景-体力活动（PA）预测心血管疾病死亡率在整个人口。方法和结果-来自836例植入式心律转复除颤器患者的数据，这些患者没有或有心脏除颤治疗，参加了InSync Sentry Optimalization功能预测心力衰竭的灵敏度（SENSE-HF）（1）研究和心力衰竭诊断结果试验（DOT-HF）。这些设备连续测量和存储每日总活动时间（单轴加速计）。早期PA（最早30天研究期间的平均每日活动）被研究作为死亡或HF相关住院时间（主要终点）的预测因子。分析了781例患者的数据（65 ± 10岁; 85%为男性;左心室射血分数，26 ± 7%）。年龄较大、身高较矮、缺血性原因、外周动脉疾病、房颤、糖尿病、啰音、外周水肿、较高的纽约心脏协会分级、较低的舒张压和未使用血管紧张素II受体阻滞剂/血管紧张素转换酶抑制剂与早期PA减少相关。主要终点发生在135例患者中（随访15 +/- 7个月）。在包括基线变量的多变量分析中，早期PA预测死亡或HF住院，每天每增加10分钟活动，风险降低4%（风险比[HR]，0.96;置信区间[CI]，0.94-0.98;与具有相同基线变量但不含PA的模型相比，P=0.0002）。PA还预测了死亡（HR，0.93; CI，0.90-0.96; P < 0.0001）和HF住院（HR，0.97; CI，0.95-0.99;结论：在慢性HF患者中，在除颤器植入或心脏除颤治疗后30天窗口期内平均的早期PA预测死亡或HF住院，以及死亡率和HF住院率，考虑基线HF严重程度。临床试验注册信息-URL：http://www.clinicaltrials.gov。唯一标识符：NCT 00400985，NCT 00480077。
Background-Physical activity (PA) predicts cardiovascular mortality in the population at large. Less is known about its prognostic value in patients with chronic heart failure (HF).Methods and Results-Data from 836 patients with implantable cardioverter defibrillator without or with cardiac resynchronization therapy enrolled in the Sensitivity of the InSync Sentry OptiVol feature for the prediction of Heart Failure (SENSE-HF)(1) study and the Diagnostic Outcome Trial in Heart Failure (DOT-HF) were pooled. The devices continuously measured and stored total daily active time (single-axis accelerometer). Early PA (average daily activity over the earliest 30-day study period) was studied as a predictor of time to death or HF-related hospital admission (primary end point). Data from 781 patients were analyzed (65 +/- 10 years; 85% men; left ventricular ejection fraction, 26 +/- 7%). Older age, shorter height, ischemic cause, peripheral artery disease, atrial fibrillation, diabetes mellitus, rales, peripheral edema, higher New York Heart Association class, lower diastolic blood pressure, and no angiotensin II receptor blocker/angiotensin-converting enzyme inhibitor use were associated with reduced early PA. The primary end point occurred in 135 patients (15 +/- 7 months of follow-up). In multivariable analysis including baseline variables, early PA predicted death or HF hospitalization, with a 4% reduction in risk for each 10 minutes per day additional activity (hazard ratio [HR], 0.96; confidence interval [CI], 0.94-0.98; P=0.0002 compared with a model with the same baseline variables but without PA). PA also predicted death (HR, 0.93; CI, 0.90-0.96; P < 0.0001) and HF hospitalization (HR, 0.97; CI, 0.95-0.99; P=0.011).Conclusions-Early PA, averaged over a 30-day window early after defibrillator implantation or cardiac resynchronization therapy in patients with chronic HF, predicted death or HF hospitalization, as well as mortality and HF hospitalization separately, accounting for baseline HF severity.Clinical Trial Registration Information-URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00400985, NCT00480077.