OBJECTIVES 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.

中文翻译：

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植入式设备测量的体育活动与心力衰竭住院的关系。

目的评估植入后5年的随访期间的身体活动（PA）水平和纵向PA轨迹与复合性心力衰竭住院和死亡率终点的关联。背景技术在植入式心脏复律除颤器（ICD）或心脏再同步治疗除颤器（CRT-D）植入后早期，低设备测量的PA与不良预后相关。方法我们将来自ICD或CRT-D植入患者的Boston Scientific ALTITUDE数据集的每日PA数据与Medicare索赔数据相关联。我们使用联合模型来研究复合终点与以下因素的关联：1）PA的时变点估计和2）随访期间PA的时变轨迹/斜率。结果在20927名患者中位活动水平为85分钟/天的患者中，有14.1％和49名患者。6％的人在1年和5年时经历了复合终点。调整后的关节模型结果显示，相对于85分钟的PA，每日PA的75分钟复合终点的危害增加了1.13倍（95％置信区间：1.12至1.13）。在8个星期内，患者的平均每日PA从85分钟降低到75分钟，即10分钟内，复合终点的危险比为4.02（95％置信区间：3.82至4.22）。结论PA大量降低的患者发生心力衰竭住院或死亡的风险明显更高。来自可植入设备的PA数据可在临床代偿失调之前识别患者。13）相对于85分钟的PA，每日PA的75分钟复合终点的危害增加了几倍；在8个星期内，患者的平均每日PA从85分钟下降到75分钟，即10分钟内，复合终点的危险比为4.02（95％置信区间：3.82至4.22）。结论PA大量降低的患者发生心力衰竭住院或死亡的风险明显更高。来自可植入设备的PA数据可在临床代偿失调之前识别患者。13）相对于85分钟的PA，每日PA的75分钟复合终点的危害增加了几倍；在8个星期内，患者的平均每日PA从85分钟下降到75分钟，即10分钟内，复合终点的危险比为4.02（95％置信区间：3.82至4.22）。结论PA大量降低的患者发生心力衰竭住院或死亡的风险明显更高。来自可植入设备的PA数据可在临床代偿失调之前识别患者。结论PA大量降低的患者发生心力衰竭住院或死亡的风险明显更高。来自可植入设备的PA数据可在临床代偿失调之前识别患者。结论PA大量降低的患者发生心力衰竭住院或死亡的风险明显更高。来自可植入设备的PA数据可在临床代偿失调之前识别患者。