Kramer Daniel B, Mitchell Susan L, Monteiro Joao, Jones Paul W, Normand Sharon-Lise, Hayes David L, Reynolds Matthew R
Beth Israel Deaconess Medical Center, Boston, MA (D.B.K., S.L.M.) Harvard Medical School, Boston, MA (D.B.K., S.L.M., S.L.N.) Hebrew SeniorLife Institute for Aging Research, Boston, MA (D.B.K., S.L.M.).
North American Science Associates, Inc, Minneapolis, MN (J.M.).
J Am Heart Assoc. 2015 May 15;4(5):e001775. doi: 10.1161/JAHA.115.001775.
Physical activity data are collected automatically by implantable cardioverter-defibrillators (ICDs). Though these data potentially provide a quantifiable and easily accessible measure of functional status, its relationship with survival has not been well studied.
Patients enrolled in the Boston Scientific LATITUDE remote monitoring system from 2008 to 2012 with ICDs were eligible. Remote monitoring data were used to calculate mean daily activity at baseline (30 to 60 days after implantation), and longitudinally. Cox regression was used to examine the association between survival and increments of 30 minutes/day in both (1) mean baseline activity and (2) time-varying activity, with both adjusted for demographic and device characteristics. A total of 98 437 patients were followed for a median of 2.2 years (mean age of 67.7±13.1 years; 71.7% male). Mean baseline daily activity was 107.5±66.2 minutes/day. The proportion of patients surviving after 4 years was significantly higher among those in the most versus least active quintile of mean baseline activity (90.5% vs. 50.0%; log-rank P value, <0.001). Lower mean baseline activity (i.e., incremental difference of 30-minutes/day) was independently associated with a higher risk of death (adjusted hazard ratio [AHR], 1.44; 95% confidence interval [CI], 1.427 to 1.462). Time-varying activity was similarly associated with a higher risk of death (AHR, 1.48; 95% CI, 1.451 to 1.508), indicating that a patient having 30 minutes per day less activity in a given month has a 48% increased hazard for death when compared to a similar patient in the same month.
Patient activity measured by ICDs strongly correlates with survival following ICD implantation.
植入式心律转复除颤器（ICD）可自动收集身体活动数据。尽管这些数据可能提供一种可量化且易于获取的功能状态测量方法，但其与生存率的关系尚未得到充分研究。
纳入2008年至2012年参与波士顿科学公司LATITUDE远程监测系统且植入ICD的患者。远程监测数据用于计算基线（植入后30至60天）及纵向的平均每日活动量。采用Cox回归分析生存与以下两项指标中每天增加30分钟的关联：（1）平均基线活动量；（2）随时间变化的活动量，同时对人口统计学和设备特征进行校正。共对98437例患者进行了中位数为2.2年的随访（平均年龄67.7±13.1岁；男性占71.7%）。平均基线每日活动量为107.5±66.2分钟/天。平均基线活动量处于最活跃与最不活跃五分位数的患者中，4年后存活患者的比例差异显著（90.5%对50.0%；对数秩P值<0.001）。较低的平均基线活动量（即每天增加30分钟的差异）与较高的死亡风险独立相关（校正风险比[AHR]为1.44；95%置信区间[CI]为1.427至1.462）。随时间变化的活动量同样与较高的死亡风险相关（AHR为1.48；95%CI为1.451至1.508），这表明与同一月份的类似患者相比，某一患者在给定月份每天活动量减少30分钟，其死亡风险增加48%。
ICD测量的患者活动量与ICD植入后的生存率密切相关。
