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. 2017 Nov 1;19(11):1841-1847.
doi: 10.1093/europace/euw267.

Patterns of physical activity and survival following cardiac resynchronization therapy implantation: the ALTITUDE activity study

Daniel B Kramer  1   2   3 , Paul W Jones  4 , Tyson Rogers  5 , Susan L Mitchell  2   3 , Matthew R Reynolds  1   6   7
Affiliations

Patterns of physical activity and survival following cardiac resynchronization therapy implantation: the ALTITUDE activity study

Daniel B Kramer et al. Europace. .

Abstract

Aims: Cardiac resynchronization therapy with implantable defibrillator backup (CRT-D) improves outcomes, but predictors and markers of response remain limited. Physical activity information collected by CRT devices may provide insights to CRT response and the relationship between activity changes and survival.

Methods and results: Patients entered into the LATITUDE remote monitoring system from 2008 to 2012 after receipt of a new CRT-D were eligible. Mean daily activity was calculated from LATITUDE uploads at baseline (first 3-10 days following implant) and 6 months (180-210 days). Pairwise differences for baseline-6-month activity were calculated, and survival according to quintiles of 6-month activity change was assessed. Cox regression was used to examine the adjusted association between survival and baseline-6-month activity change. A total of 26 509 patients were followed for a median of 2.3 years (mean age 70.2 ± 11.0 years, 70.7% male). Mean baseline activity was 66.2 ± 47.7 min/day, with mean paired increase at 6 months of 37.1 ± 48.2 min/day [95% CI (confidence interval), 36.5-37.6, P < 0.0001], though 15.5% of patients did not improve or worsened at 6 months. Survival at 3 years was significantly higher in the largest baseline-6-month activity change quintile vs. the lowest quintile (88.9% vs. 62.1%, log-rank P-value < 0.001). Adjusted for age and gender, higher 6-month activity change was associated with a lower risk of death (adjusted hazard ratios 0.65 per 30 min increase in activity, 95% CI, 0.63-0.67).

Conclusions: Change in physical activity between baseline and 6 months following CRT implantation is strongly associated with survival.

Keywords: Cardiac resynchronization therapy; Exercise; Heart failure; Outcomes research; Remote monitoring.

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Figures

Figure 1
Figure 1
Derivation of study cohort.
Figure 2
Figure 2
Definitions of activity ‘windows’ according to timing relative to implantation of CRT device.
Figure 3
Figure 3
Activity changes for entire cohort, measured as the difference in activity between baseline (average minutes per day over days 3–10) and 6 months (average minutes per day over days 180–210).
Figure 4
Figure 4
Survival and number of patients at risk for study population stratified by quintile of activity change between baseline (average min/day over days 3–10) and 6 months (average min/day over days 180–210).
Figure 5
Figure 5
Multivariate analysis of patient characteristics and survival following CRT-defibrillator implantation. Baseline and 6-month change in activity level HR describe hazard for death assumed with every 30 min increase in activity, adjusted for other factors.
See this image and copyright information in PMC

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