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. 2015 May 15;4(5):e001775.
doi: 10.1161/JAHA.115.001775.

Patient Activity and Survival Following Implantable Cardioverter-Defibrillator Implantation: The ALTITUDE Activity Study

Daniel B Kramer  1 , Susan L Mitchell  1 , Joao Monteiro  2 , Paul W Jones  3 , Sharon-Lise Normand  4 , David L Hayes  5 , Matthew R Reynolds  6
Affiliations

Patient Activity and Survival Following Implantable Cardioverter-Defibrillator Implantation: The ALTITUDE Activity Study

Daniel B Kramer et al. J Am Heart Assoc. .

Abstract

Background: Physical activity data are collected automatically by implantable cardioverter-defibrillators (ICDs). Though these data potentially provide a quantifiable and easily accessible measure of functional status, its relationship with survival has not been well studied.

Methods and results: Patients enrolled in the Boston Scientific LATITUDE remote monitoring system from 2008 to 2012 with ICDs were eligible. Remote monitoring data were used to calculate mean daily activity at baseline (30 to 60 days after implantation), and longitudinally. Cox regression was used to examine the association between survival and increments of 30 minutes/day in both (1) mean baseline activity and (2) time-varying activity, with both adjusted for demographic and device characteristics. A total of 98 437 patients were followed for a median of 2.2 years (mean age of 67.7±13.1 years; 71.7% male). Mean baseline daily activity was 107.5±66.2 minutes/day. The proportion of patients surviving after 4 years was significantly higher among those in the most versus least active quintile of mean baseline activity (90.5% vs. 50.0%; log-rank P value, <0.001). Lower mean baseline activity (i.e., incremental difference of 30-minutes/day) was independently associated with a higher risk of death (adjusted hazard ratio [AHR], 1.44; 95% confidence interval [CI], 1.427 to 1.462). Time-varying activity was similarly associated with a higher risk of death (AHR, 1.48; 95% CI, 1.451 to 1.508), indicating that a patient having 30 minutes per day less activity in a given month has a 48% increased hazard for death when compared to a similar patient in the same month.

Conclusions: Patient activity measured by ICDs strongly correlates with survival following ICD implantation.

Keywords: death; implantable cardioverter‐defibrillators; sudden.

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Figures

Figure 1
Figure 1
Study flow with derivation of the study population.
Figure 2
Figure 2
Survival and number of patients at risk for entire study population and stratified by quintile of patient baseline daily activity.
See this image and copyright information in PMC

References

    1. Epstein AE, Dimarco JP, Ellenbogen KA, Estes NA, III, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. Heart Rhythm. 2008;5:e1–62. - PubMed
    1. Kramer DB, Friedman PA, Kallinen LM, Morrison TB, Crusan DJ, Hodge DO, Reynolds MR, Hauser RG. Development and validation of a risk score to predict early mortality in recipients of implantable cardioverter-defibrillators. Heart Rhythm. 2012;9:42–46. - PubMed
    1. Bilchick KC, Stukenborg GJ, Kamath S, Cheng A. Prediction of mortality in clinical practice for medicare patients undergoing defibrillator implantation for primary prevention of sudden cardiac death. J Am Coll Cardiol. 2012;60:1647–1655. - PMC - PubMed
    1. Chen CY, Stevenson LW, Stewart GC, Seeger JD, Williams L, Jalbert JJ, Setoguchi S. Impact of baseline heart failure burden on post-implantable cardioverter-defibrillator mortality among medicare beneficiaries. J Am Coll Cardiol. 2013;61:2142–2150. - PMC - PubMed
    1. Alba AC, Braga J, Gewarges M, Walter SD, Guyatt GH, Ross HJ. Predictors of mortality in patients with an implantable cardiac defibrillator: a systematic review and meta-analysis. Can J Cardiol. 2013;29:1729–1740. - PubMed

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