Utility of cardiovascular implantable electronic device–derived patient activity to predict clinical outcomes

Spencer Z. Rosero, Arwa Younis, Paul Jones, Scott McNitt, Ilan Goldenberg, Wojciech Zareba, Kenneth Stein, Valentina Kutyifa

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The role of cardiovascular implantable electronic device (CIED)–derived activity to predict implantable cardioverter-defibrillator (ICD) therapy or death is not known. Objective: We aimed to assess CIED-derived activity to predict clinical outcomes. Methods: In 1500 patients enrolled in MADIT-RIT, CIED-derived patient activity was acquired daily, then averaged for the first 30 days following randomization to predict inappropriate/appropriate therapy or death. Kaplan-Meier analysis and Cox proportional regression models were used to evaluate inappropriate/appropriate therapy, heart failure, or death by 30-day CIED-derived patient activity quintiles. Results: There were 1463 patients with CIED activity data (98%). Patients in the highest quintile (Q5) of activity (more active) had the highest rate of inappropriate therapy, 21% at 2 years, as compared to 7%–11% in the other 4 quintiles (P <.001), a 1.75 times higher risk (95% confidence interval [CI]: 1.23–2.50, P =.002). However, patients in the lowest quintile of activity (Q1, 1 hour/day) had the highest risk of mortality, 15% in 2 years, as compared to Q2–3 (1–2 hours/day, 8%–7% mortality), and Q4–5 (>2 hours/day, 2%–3% mortality) (P <.001). Patients with the lowest level of activity (Q1) had a 2.02 times higher risk of mortality (95% CI: 1.21–3.38, P =.007), and they had an 82% higher risk of heart failure hospitalization (95% CI: 1.28–2.57, P =.001). Conclusions: High CIED-derived 30-day median patient activity predicted inappropriate therapy, while low patient activity predicted mortality and heart failure in ICD and cardiac resynchronization therapy with defibrillator patients enrolled in MADIT-RIT. Device-derived activity assessment could serve as a useful predictor of outcomes.

Original languageEnglish
Pages (from-to)1344-1351
Number of pages8
JournalHeart Rhythm
Volume18
Issue number8
DOIs
StatePublished - Aug 2021
Externally publishedYes

Keywords

  • Death
  • ICD programming
  • Inappropriate ICD therapy
  • MADIT-RIT
  • Outcome

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