Objective Data on cardiovascular outcomes according to objectively measured physical activity (PA) in patients with atrial fibrillation (AF) are scarce. This study explored the associations between PA derived from wrist-worn accelerometers and the risk of death, incident heart failure (HF), and incident stroke in patients with AF. Methods From 37 990 patients with AF in UK Biobank, 2324 patients with accelerometer data were included. Weekly moderate-to-vigorous PA (MVPA) duration was computed from accelerometer data. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, incident HF, and incident stroke. Restricted cubic splines estimated the dose–response associations between MVPA duration and the outcomes. The adjusted HRs (aHRs) of the outcomes according to adherence to PA standard guidelines (performing MVPA≥150 min/week) were also evaluated. Results The mean age was 66.9±6.2 years and 64.9% were male. During a median follow-up of 6.7 years, there were 181 all-cause deaths, 62 cardiovascular deaths, 225 cases of incident HF, and 91 cases of incident stroke; the overall incidence rate per 1000 patient-years was 11.76, 4.03, 15.16 and 5.99, respectively. There was a linear inverse dose–response relationship between MVPA (≥108 min/week) and all-cause mortality. Performing MVPA for 105–590 min/week was associated with a lower risk of HF than those with no measurable MVPA. The risk of stroke and cardiovascular mortality was not associated with MVPA. Performing guideline-adherent MVPA was related to a 30% lower risk of all-cause mortality (aHR: 0.70 (0.50–0.98), p=0.04) and 33% lower risk of HF (aHR 0.67 (0.49–0.93), p=0.02). Conclusion In patients with AF, accelerometer-derived PA data supports lower risks of all-cause mortality and HF according to a greater level of MVPA and adherence to PA guidelines. Regular MVPA should be encouraged in patients with AF as a part of integrated management. Data are available upon reasonable request.

中文翻译：

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加速度计衍生的体力活动与房颤患者死亡、心力衰竭和中风的风险：英国生物银行的一项前瞻性研究

客观 根据客观测量的房颤 (AF) 患者体力活动 (PA) 得出的心血管结局数据很少。本研究探讨了腕戴式加速度计产生的 PA 与 AF 患者死亡、心力衰竭 (HF) 和中风风险之间的关联。方法 从英国生物银行的 37 990 例 AF 患者中，纳入 2 324 例有加速度计数据的患者。根据加速度计数据计算每周中度至剧烈 PA (MVPA) 持续时间。主要结局是全因死亡率。次要结局是心血管死亡率、心力衰竭事件和卒中事件。受限三次样条估计了 MVPA 持续时间和结果之间的剂量反应关联。还评估了根据 PA 标准指南（执行 MVPA≥150 分钟/周）调整后的结果 HR (aHR)。结果 平均年龄为66.9±6.2岁，其中男性占64.9%。在中位随访 6.7 年期间，有 181 例全因死亡、62 例心血管死亡、225 例心衰病例和 91 例中风病例；每1000患者年的总发病率分别为11.76、4.03、15.16和5.99。 MVPA（≥108 分钟/周）与全因死亡率之间存在线性反剂量反应关系。与没有可测量 MVPA 的患者相比，每周进行 105-590 分钟的 MVPA 与心力衰竭风险较低相关。中风和心血管死亡的风险与 MVPA 无关。遵循指南进行 MVPA 可使全因死亡率风险降低 30%（aHR：0.70 (0.50–0.98)，p=0.04），心力衰竭风险降低 33%（aHR 0.67 (0.49–0.93)，p= 0.02）。结论 在 AF 患者中，根据更高水平的 MVPA 和遵守 PA 指南，加速度计得出的 PA 数据支持降低全因死亡率和心力衰竭的风险。作为综合管理的一部分，应鼓励 AF 患者定期进行 MVPA。数据可根据合理要求提供。