Accelerometer-derived physical activity and the risk of death, heart failure, and stroke in atrial fibrillation patients: A prospective study from UK Biobank

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Data on the risk of cardiovascular outcomes according to the objectively measured physical activity (PA) in atrial fibrillation (AF) is scarce. Purpose We aimed to explore the association between accelerometer-derived PA and the risk of death, heart failure, and stroke in patients with AF. Methods From the UK Biobank prospective cohort, 2324 AF patients with valid wrist-accelerometer data recruited between 2013 and 2015 were included. Wrist accelerometers were used to define the intensity and duration of light, moderate, and vigorous PA. The primary outcomes were all-cause mortality, cardiovascular disease (CVD) mortality, heart failure (HF), and stroke. Restricted cubic splines were used to evaluate the dose-response associations between moderate to vigorous physical activity (MVPA) duration and the primary outcomes. We analyzed the adjusted hazard ratio (aHR) of primary outcomes in AF patients who adhere to the PA guideline of the World Health Organization (MVPA≥150 min/week) compared to the patients with low PA. Results The mean age was 61.1±6.2 years and 64.9% were male. During a median of 6.9 years, 184 all-cause deaths, 62 cardiovascular deaths, 225 heart failure, and 92 stroke events were observed. There was a linear inverse dose-response relationship between MVPA time (≥108 min/week) and all-cause mortality. A certain range of MPVA time (105 to 590 min/week) was associated with a lower risk of HF. The risk of stroke and CVD mortality had no significant relationships with MVPA time. AF patients with guideline-adherent PA levels have lower risks of all-cause mortality and heart failure: aHRs (95% CIs) were 0.70 (0.50-0.98), p=0.04 for all-cause mortality and 0.67 (0.49-0.93), p=0.02 for heart failure. Conclusion In this study of objectively measured PA data, AF patients with higher PA showed lower risks of all-cause mortality and heart failure. AF patients adhere to PA guideline (MVPA≥150 min/week) might have a lower risk trend of CVD mortality and stroke. Exercise should be strongly encouraged for AF patients as in the general population.