Sex Differences in Physical Activity and Its Association With Cardiac Death and All-Cause Mortality in Patients With Implantable Cardioverter-Defibrillators.

Xiaoyao Li,Xuerong Sun,Wei Hua,Wei Xu,Shuang Zhao,Keping Chen,Shu Zhang,Yangang Su,Jiefu Yang,Zhaoguang Liang,Xiaodi Xue,Zeyi Li

doi:10.3389/fcvm.2020.588622

Abstract

Objective: To clarify the impact of sex on physical activity (PA) levels among patients with implantable cardioverter-defibrillators/cardiac resynchronization therapy defibrillators (ICD/CRT-D) and its association with cardiac death and all-cause mortality.Methods: Overall, data of 820 patients with ICD/CRT-D from the SUMMIT registry were retrospectively analyzed. Baseline PA from 30 to 60 days after device implantation was measured using Biotronik accelerometer sensors. The primary and secondary endpoints were cardiac death and all-cause mortality, respectively.Results: Baseline PA levels were significantly higher in male patients than in female patients (11.40 ± 5.83% vs. 9.93 ± 5.49%, P = 0.001). Males had higher predictive PA cut-off values for cardiac death (11.16 vs. 7.15%) and all-cause mortality (11.33 vs. 7.17%). During the median follow-up time of 75.7 ± 29.1 months, patients with baseline PA<cut-off values had higher cumulative incidence of cardiac death and all-cause mortality in both males and females. At a PA level between the cut-off values of males and females, males had a higher risk of cardiac death (hazard ratio = 4.952; 95%CI = 1.055-23.245, P = 0.043) and all-cause mortality (hazard ratio = 2.432; 95%CI = 1.095-5.402, P = 0.029).Conclusions: Males had higher predictive PA cut-off values for cardiac death and all-cause mortality in patients with ICD/CRT-D. Sex should be considered as an important contributing factor when deciding for PA targets.

Highlights

Implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy defibrillators (CRT-D) have become the standard modalities for the prevention of sudden cardiac death and management of some patients with heart failure (HF) [1, 2]
KG; Berlin, Germany) implantation according to Class I therapy practice guidelines; [2] patients with ICD/CRT-D devices equipped to process daily home monitoring (HM) transmissions; [3] patients aged over 18 years; [4] patients who survived more than three months after ICD/CRT-D implantation
Both Physical activity (PA) measurements (

Summary

Introduction

Implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy defibrillators (CRT-D) have become the standard modalities for the prevention of sudden cardiac death and management of some patients with heart failure (HF) [1, 2]. It is important to identify patients at high risk for cardiac death and all-cause mortality after ICD/CRT-D implantation to improve their clinical outcomes [3,4,5,6]. A number of studies have indicated that PA is significantly associated with clinical prognosis in the healthy population and in patients with structural heart disease [7,8,9]. Despite the important role of PA in the prognostication of outcomes after ICD/CRT-D implantation, little is known about the differences between sex in PA levels among those patients

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Discussion

Conclusion