Author + information
- Received May 13, 2019
- Revision received October 8, 2019
- Accepted October 31, 2019
- Published online March 30, 2020.
- Jacob P. Kelly, MD, MHSa,b,∗ (, )
- Nicholas G. Ballew, PhDc,
- Li Lin, MSc,
- Bradley G. Hammill, DrPHa,c,
- Timothy M. Stivland, MBAd,
- Paul W. Jones, MSd,
- Lesley H. Curtis, PhDa,c,
- Adrian F. Hernandez, MD, MHSa,
- Melissa A. Greiner, MSc and
- Brett D. Atwater, MDa
- aDuke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina
- bAlaska Heart & Vascular Institute, Anchorage, Alaska
- cDepartment of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- dBoston Scientific Corporation, St. Paul, Minnesota
- ↵∗Address for correspondence:
Dr. Jacob P. Kelly, Alaska Heart & Vascular Institute, 3841 Piper Street, Suite T-100, Anchorage, Alaska 99508.
Objectives The purpose of this study was to evaluate the association of physical activity (PA) level and longitudinal PA trajectory with a composite heart failure hospitalization and mortality endpoint over a 5-year follow-up period following implantation.
Background Low device measured PA early after implantation of an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) is associated with poor outcomes.
Methods We linked daily PA data from the Boston Scientific ALTITUDE dataset of patients with ICD or CRT-D implantation to Medicare claims data. We used a joint model to investigate the association of the composite endpoint with 1) the time-varying point estimate of PA and 2) the time-varying trajectory/slope of PA during follow-up.
Results Among 20,927 patients with median activity level 85 min/day, 14.1% and 49.6% experienced the composite endpoint at 1 and 5 years. Adjusted joint model results showed that there was a 1.13 (95% confidence interval: 1.12 to 1.13)-fold increase in the hazard of the composite endpoint for 75 min of daily PA relative to 85 min of PA; and a within-patient 10-min decrease in average daily PA over an 8-week period from 85 to 75 min was associated with a hazard ratio of 4.02 (95% confidence interval: 3.82 to 4.22) for the composite endpoint.
Conclusions Patients with large decreases in PA have significantly higher risk of experiencing heart failure hospitalization or death. PA data from implantable devices may identify patients before clinical decompensation.
Dr. Kelly receives research support from Boston Scientific and Abbott Medical; and Honoraria from Novartis. Dr. Hammill has received research support from Novartis, GlaxoSmithKline, Abbott, Boston Scientific, and Abbott Medical. Mr. Stivland and Mr. Jones are employees of Boston Scientific. Dr. Curtis has received funding from Boston Scientific, GlaxoSmithKline, Gilead, NCQA, and Novartis. Dr. Hernandez has received research grants and/or personal fees from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, GlaxoSmithKline, Janssen, Luitpold, Mast Therapeutics, Merck, the National Institutes of Health/National Heart, Lung, and Blood Institute, Novartis, the Patient-Centered Outcomes Research Institute, and Portola; and has consulted for Amgen, AstraZeneca, Bayer, Boston Scientific, Merck, Novartis, and Pfizer. Dr. Atwater has received research support from Boston Scientific and Abbott Medical; and honoraria from Biosense Webster, Abbott Medical, Medtronic, and Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 13, 2019.
- Revision received October 8, 2019.
- Accepted October 31, 2019.
- 2020 American College of Cardiology Foundation
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