Abstract
BackgroundWhile exercise-based cardiac rehabilitation has a beneficial effect on heart failure hospitalization and mortality, it is limited by the presence of chronotropic incompetence (CI) in some patients. This study explored the feasibility of using wearable devices to assess impaired chronotropic response in heart failure patients.MethodsForty patients with heart failure (left ventricular ejection fraction, LVEF: 44.6 ± 5.8; age: 54.4 ± 11.7) received ECG Holter and accelerometer to monitor heart rate (HR) and physical activities during symptom-limited treadmill exercise testing, 6-min hall walk (6MHW), and 24-h daily living. CI was defined as maximal HR during peak exercise testing failing to reach 70% of age-predicted maximal HR (APMHR, 220 – age). The correlation between HR and physical activities in Holter-accelerometer recording was analyzed.ResultsOf 40 enrolled patients, 26 were able to perform treadmill exercise testing. Based on exercise test reports, 13 (50%) of 26 patients did not achieve at least 70% of APMHR (CI patients). CI patients achieved a lower % APMHR (62.0 ± 6.3%) than non-CI patients who achieved 72.0 ± 1.2% of APMHR (P < 0.0001). When Holter-accelerometer recording was used to assess chronotropic response, the percent APMHR achieved during 6MHW and physical activities was significantly lower in CI patients than in non-CI patients. CI patients had a significantly shorter 6MHW distance and less physical activity intensity than non-CI patients.ConclusionThe study found impaired chronotropic response in 50% of heart failure patients who took treadmill exercise testing. The wearable Holter-accelerometer recording could help to identify impaired chronotropic response to physical activities in heart failure patients.Trial registrationClinicalTrials.gov ID NCT02358603. Registered 16 May 2014.
Highlights
While exercise-based cardiac rehabilitation has a beneficial effect on heart failure hospitalization and mortality, it is limited by the presence of chronotropic incompetence (CI) in some patients
The inclusion criteria included: (1) patients had heart failure based on ESC 2012 heart failure guidelines; (2) patients’ NYHA classification was ranged from I to III and left ventricular ejection fraction (LVEF) was more than 35%; (3) patients were capable of performing moderate exercise
There was no significant difference in clinical characteristics between patients taking treadmill exercise testing and those not taking (Table 2)
Summary
While exercise-based cardiac rehabilitation has a beneficial effect on heart failure hospitalization and mortality, it is limited by the presence of chronotropic incompetence (CI) in some patients. This study explored the feasibility of using wearable devices to assess impaired chronotropic response in heart failure patients. Heart failure patients experience a variety of symptoms, of which the most frequently presenting symptoms are exertional breathlessness, fatigue, and intolerance to physical activities, leading to poor quality of life. Patients with heart failure were suggested to avoid exertion, exercise-based cardiac rehabilitation has been recognized as having a beneficial effect on heart failure hospitalization and mortality [1,2,3,4]. In response to physical exercise that increases oxygen demand, heart rate (HR), via enhanced sympathetic activity and/or withdrawal of parasympathetic activity, increases to meet the body’s metabolic demand.
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