Association between regular exercise and the risk of major adverse cardiovascular events in patients with pacemaker

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background The optimal amount of exercise for preventing cardiovascular events in patients with pacemakers has not been revealed. Methods Using the Korean National Health Insurance Service database, patients who had newly implanted pacemakers between 2009 and 2018 were included. The amount of physical activity was measured by a self-reported questionnaire included in the national health examination. Performing regular exercise was defined as ≥5 days of moderate-intensity exercise or ≥3 days of vigorous-intensity exercise per week. The occurrence of major adverse cardiovascular events (MACE) defined as the composite of stroke, heart failure, myocardial infarction, and all-cause death was evaluated during follow-up. Results A total of 13,542 patients were included (mean age 68±11 years, 45% of men); 51% of patients were atrioventricular block and 39% of patients were sick sinus syndrome, and 85% of patients were implanted with dual-chamber pacemaker. During a median 2.5-year of follow-up, the incidence rates of MACE was 5.4 and 3.7 per 100 person-years in non-exerciser and exerciser, respectively (Figure A). Compared to non-exerciser, patients performing regular exercise were associated with a lower risk of MACE (hazard ratio, 95% confidence interval: 0.745, 0.661-0.839, p<0.001, Figure B). Patients with ≥450 metabolic equivalents (METs) which was the highest quartile cut-off of exercise amount were significantly associated with a lower risk of MACE (0.765, 0.686-0.853, p<0.001) than patients with <450 METs. Compared to persistent non-exerciser before and after pacemaker implantation, persistent exercisers and exercise-starters showed a significantly lower risk of MACE (0.788, 0.662-0.938, p=0.007 and 0.584, 0.462-0.738, p<0.001, respectively, Figure C). Conclusion Regular physical activity was related to the risk of MACE in patients with pacemaker. A proactive cardiac rehabilitation program would be considered for this population.