Abstract 95 Impact of the COVID-19 pandemic on physical activity of patients with cardiac implantable electronic devices

Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9
Impact of the COVID-19 pandemic on physical activity of patients with cardiac implantable electronic devices
M. T. Huttelmaier¹, M. Seewald², A. Gabel³, S. Störk⁴, S. Frantz², T. H. Fischer¹
¹Med. Klinik und Poliklinik I, Klinische Elektrophysiologie, Universitätsklinikum Würzburg, Würzburg; ²Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg, Würzburg; ³Institut für Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle; ⁴Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum Würzburg, Würzburg;
Introduction: To contain COVID-19 and protect patients at particular risk, extensive occupational and social restrictions were implemented during the pandemic. In case of COVID-19 infection, cardiovascular disease (CD) is a major independent risk factor for mortality. Physical inactivity, potentially enhanced by curfews, constitutes a risk factor for CD itself. Remote monitoring through cardiac implantable electronic devices (CIED) offers the possibility to monitor physical activity (PA) continuously in addition to device-related parameters. Methods: In this single centre retrospective, observational cohort study we assessed PA, heart rate, atrial arrhythmia burden and implantable cardioverter defibrillator (ICD) therapies via remote monitoring over a two-year period in a German tertiary care hospital with a catchment of about 2.5 Mio. inhabitants. We focussed on a 338-day period during COVID-19 pandemic in 2020 that was subdivided into 6 specific time-periods defined by public health interventions of exceptional significance. All time-intervals were compared to respective control-periods of the year 2019 to adjust for seasonal variations. Primary outcome was the impact of COVID-19 pandemic on PA. Secondary outcome was the count of ICD therapies in the ICD-subgroup. Paired nonparametric longitudinal data analysis was performed to detect statistically significant differences between time periods. To model effects of age and time, a nonparametric ANOVA-type-statistic based on ranks with repeated measures and a two-factorial design were applied. Results: In this cohort of 147 CIED patients carrying ICDs (92.5%), pacemakers (5.4%) or eventrecorders (2.0%), longitudinal analysis of PA in 2019 and 2020 showed a distinct weekly periodicity with significant drops of PA on Sundays and a typical seasonal pattern with peaking PA levels in early summer followed by a constant decline with the nadir in winter months. Mean PA was significantly reduced during the pandemic (mean daily PA 2019: 12.43% vs. 2020: 11.43%; p<0.0001). Comparing corresponding time intervals between both years, lockdown (LD) periods showed the most pronounced PA reduction (LD I: fold change (FC) 0.885 (=11.5%), p<0.0001; LD II: FC 0.889 (=11.1%), p<0.0001). Of note, PA was persistently decreased in every time-period of the year 2020 compared to 2019 in older patients (> 70 years). However, reflecting a resumption of normal PA levels following LD periods, PA of younger patients (≤ 70 years) was not different compared to 2019 in time-periods of eased restrictions. In time-periods when PA was reduced in both age groups, the decrease of PA was more pronounced in older patients. Neither the comparison of intervals within a year (2019, 2020) nor the comparison of corresponding intervals between years revealed a significant variation in heart rate, ICD therapies and atrial arrhythmia burden. Conclusion: PA shows a weekly periodicity and a seasonal pattern. During COVID-19 pandemic, PA was significantly reduced in CIED patients, with the most pronounced reduction during LD periods. Younger patients resumed their former level of PA in times of eased restrictions, while older patients remained less active in equivalent time-periods and experienced stronger PA reduction in LD periods. Thus, multimodal motivation and activation of the susceptible elderly population is necessary and of great importance to prevent long-term health impairments during and after the pandemic.
https://dgk.org/kongress_programme/ht2021/P322.htm