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Early Increased Physical Activity, Cardiac Rehabilitation, and Survival After Implantable Cardioverter-Defibrillator Implantation
Circulation: Cardiovascular Quality and Outcomes ( IF 6.9 ) Pub Date : 2021-07-21 , DOI: 10.1161/circoutcomes.120.007580
Brett D Atwater 1, 2 , Zhen Li 3 , Jessica Pritchard 3 , Melissa A Greiner 3 , Yelena Nabutovsky 4 , Bradley G Hammill 3
Affiliation  

Background:Increased physical activity (PA) through cardiac rehabilitation (CR) improves outcomes in patients with heart failure and coronary disease, but CR referral remains infrequent. Implantable cardioverter-defibrillators (ICDs) can provide daily PA measurements to patients that may motivate them to increase PA, but it remains unclear if increased ICD measured PA is associated with improved outcomes with and without CR.Methods:This is a retrospective observational study of 41 731 Medicare beneficiaries with ICD implantation between January 1, 2014 and December 31, 2016. We linked daily ICD PA measurements and Medicare claims data to determine if increased PA is associated with a reduction in the likelihood of death or heart failure hospitalization. To determine if CR participation altered the effect of PA on outcomes, we performed two additional analyses matching CR participants and nonparticipants using propensity scores. The first match included demographics, comorbidities, and baseline PA measurements. The second match also included the change in PA measured during CR or the same time frame after ICD implant among nonparticipants.Results:The mean age was 75 (SD, 10) years, 30 182 beneficiaries (72.3%) were male, and 1324 (3%) participated in CR. Increased ICD detected PA was associated with improved survival. CR participants had a mean PA change of +9.7 (SD, 57.8) min/d, whereas nonparticipants had a mean change of −1.0 (SD, 59.7) min/d (P<0.001). After matching for demographics, comorbidities and baseline PA, CR participants had significantly lower 1- to 3-year mortality (hazard ratio, 0.76 [95% CI, 0.69–0.85], P=0.03). After additionally matching for the ICD measured change in PA during CR there were no differences in mortality with and without CR (hazard ratio, 1.00 [95% CI, 0.82–1.21], P=0.87). Every 10 minutes of increased daily PA was associated with a 1.1% reduction in all-cause mortality in both groups.Conclusions:Among Medicare beneficiaries with ICDs, small increases in PA were associated with significant reductions in all-cause mortality.

中文翻译:

植入式心脏复律除颤器植入后早期增加的体力活动、心脏康复和存活率

背景:通过心脏康复 (CR) 增加体力活动 (PA) 可改善心力衰竭和冠心病患者的预后,但转诊 CR 的情况仍然很少。植入式心律转复除颤器 (ICD) 可以为患者提供每日 PA 测量值,这可能会促使他们增加 PA,但尚不清楚增加 ICD 测量的 PA 是否与有或没有 CR 的改善结果相关。方法:这是一项回顾性观察研究41 731 名在 2014 年 1 月 1 日至 2016 年 12 月 31 日期间植入 ICD 的医疗保险受益人。我们将每日 ICD PA 测量值与医疗保险索赔数据联系起来,以确定 PA 增加是否与死亡或心力衰竭住院的可能性降低有关。为了确定 CR 参与是否改变了 PA 对结果的影响,我们使用倾向评分对 CR 参与者和非参与者进行了两项额外的分析。第一场比赛包括人口统计学、合并症和基线 PA 测量值。第二场比赛还包括非参与者在 CR 期间或 ICD 植入后相同时间范围内测量的 PA 变化。结果:平均年龄为 75 (SD, 10) 岁,30 182 名受益人 (72.3%) 为男性,1324 ( 3%) 参与了 CR。ICD 检测到的 PA 增加与生存率提高有关。CR 参与者的平均 PA 变化为 +9.7 (SD, 57.8) min/d,而非参与者的平均变化为 -1.0 (SD, 59.7) min/d ( 第二场比赛还包括非参与者在 CR 期间或 ICD 植入后相同时间范围内测量的 PA 变化。结果:平均年龄为 75 (SD, 10) 岁,30 182 名受益人 (72.3%) 为男性,1324 ( 3%) 参与了 CR。ICD 检测到的 PA 增加与生存率提高有关。CR 参与者的平均 PA 变化为 +9.7 (SD, 57.8) min/d,而非参与者的平均变化为 -1.0 (SD, 59.7) min/d ( 第二场比赛还包括非参与者在 CR 期间或 ICD 植入后相同时间范围内测量的 PA 变化。结果:平均年龄为 75 (SD, 10) 岁,30 182 名受益人 (72.3%) 为男性,1324 ( 3%) 参与了 CR。ICD 检测到的 PA 增加与生存率提高有关。CR 参与者的平均 PA 变化为 +9.7 (SD, 57.8) min/d,而非参与者的平均变化为 -1.0 (SD, 59.7) min/d (P <0.001)。在匹配人口统计学、合并症和基线 PA 后,CR 参与者的 1 至 3 年死亡率显着降低(风险比,0.76 [95% CI,0.69-0.85],P = 0.03)。在额外匹配 ICD 测量的 CR 期间 PA 的变化后,有和没有 CR 的死亡率没有差异(风险比,1.00 [95% CI,0.82-1.21],P = 0.87)。两组每天每增加 10 分钟体力活动,全因死亡率降低 1.1%。
更新日期:2021-08-17
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