Analysis of daily activity data from implanted cardiac defibrillators: The minimum clinically important difference and relationship to mortality/life expectancy

DOI: 10.4236/wjcd.2012.23021   PDF   HTML     4,557 Downloads   7,888 Views   Citations


Background: Daily activity is a potentially important measure for assessing prognosis in individuals with chronic heart failure (CHF), and few studies have investigated the prognostic value of daily activity measurement. The present study sought to determine whether there is an association between daily activity and mortality/mean life expectancy as predicted by the Seattle Heart Failure Model (SHFM), and to provide an estimate of the anchor-based minimum clinically important difference (MCID) for daily activity measured by single-axis accelerometers in implanted cardiac defibrillators. Methods: This study utilized a retrospective chart review of 102 medical records of patients with CHF and Medtronic? implanted cardiac defibrillators (ICDs). Mean daily activity was calculated for a two week period prior to both a baseline and follow-up routine clinical visit. Clinical characteristics from the baseline clinic visit were used for calculating SHFM estimates of mean life expectancy, 1-year mortality, and 5-year mortality. A five-point global rating scale was scored based on documented clinician impression, patient self-report, and laboratory and cardiographic tests for determining the MCID. Results: There was a moderate correlation between baseline daily activity and each of the SHFM prognostic indicators: 1-year mortality (r = 0.36, p < 0.001, 5-year mortality (r = 0.40, p < 0.001), and life expectancy (r = 0.43, p < 0.001). The MCID for a decline in daily activity was approximately 0.5 hours and was approximately 1.0 hours for improvement in daily activity. Conclusions: Although previous re- search has established the short-term predictive value of ICD-measured daily activity for CHF-related clinical events, no prior study has examined the longer-term prognostic value of ICD-based daily activity. The results of the present study suggest that low daily activity, as recorded by ICDs in patients with CHF, should prompt a more formal evaluation of prognosis using the SHFM. Furthermore, changes of 0.5 to 1.0 hours of activity per day appear to be clinically mean- ingful.

Share and Cite:

Shoemaker, M. , Curtis, A. , Vangsnes, E. , Dickinson, M. and Paul, R. (2012) Analysis of daily activity data from implanted cardiac defibrillators: The minimum clinically important difference and relationship to mortality/life expectancy. World Journal of Cardiovascular Diseases, 2, 129-135. doi: 10.4236/wjcd.2012.23021.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Oka, R.K., Gortner, S.R., Stotts, N.A. and Haskell, W.L. (1996) Predictors of physical activity with chronic heart failure secondary to either ischemic or idiopathic dilated cardiomyopathy. American Journal of Cardiology, 77, 159-163. doi:10.1016/S0002-9149(96)90588-3
[2] Van den Berg-Emons, H., Bussmann, J., Balk, A., et al. (2001) Level of activities associated with mobility during everyday life in patients with chronic congestive heart failure as measured with an “Activity Monitor.” Physical Therapy, 81, 1502-1511.
[3] Davies, S.W., Jordan, S.L. and Lipkin, D.P. (1992) Use of limb movement sensors as indicators of the level of everyday physical activity in chronic congestive heart failure. American Journal of Cardiology, 69, 1581-1586. doi:10.1016/0002-9149(92)90707-6
[4] Hoodless, D.J., Stainer, K., Savic, N., et al. (1994) Reduced customary activity in chronic heart failure: Assessment with a new shoe-mounted pedometer. Internati- onal Journal of Cardiology, 43, 39-42. doi:10.1016/0167-5273(94)90088-4
[5] Walsh, J.T., Andrews, R., Evans, A. and Cowley, A.J. (1995) Failure of “effective” treatment for heart failure to improve customary activity. British Heart Journal, 70, 373-376. doi:10.1136/hrt.74.4.373
[6] Toth, M.J., Gottlieb, S.S., Goran, M.I., et al. (1997) Daily energy expenditure in free-living heart failure patients. American Journal of Physiology, 272, E469-E475.
[7] van den Berg-Emons, R., Balk, A., Bussmann, H. and Stam, H. (2004) Does aerobic training lead to a more active lifestyle and improved quality of life in patients with chronic heart failure? European Journal of Heart Failure, 6, 95-100. doi:10.1016/j.ejheart.2003.10.005
[8] Oka, R.K., Stotts, N.A., Dae, M.W., et al. (1993) Daily physical activity levels in congestive heart failure. American Journal of Cardiology, 71, 921-925. doi:10.1016/0002-9149(93)90907-T
[9] Witham, M.D., Argo, I.S., Johnston, D.W., Struthers, A.D. and McMurdo, M.E.T. (2006) Predictors of exercise capacity and everyday activity in older heart failure patients. European Journal of Heart Failure, 8, 203-207. doi:10.1016/j.ejheart.2005.03.008
[10] Willenheimer, Rydberg, E., Cline, C., et al. (2001) Effects on quality of life symptoms, and daily activity 6 months after termination of an exercise programme in heart failure patients. International Journal of Cardiology, 77, 25- 31. doi:10.1016/S0167-5273(00)00383-1
[11] Witham, M.D., Gray, J.M. and Argo, I.S. (2005) Effect of a seated exercise program to improve physical function and health status in frail patients > 70 years of age with heart failure. American Journal of Cardiology, 95, 1120- 1124. doi:10.1016/j.amjcard.2005.01.031
[12] Mueller, L., Myers, J., Kottman, W., et al. (2007) Exercise capacity, physical activity patterns and outcomes six years after cardiac rehabilitation in patients with heart failure. Clinical Rehabilitation, 21, 923-931. doi:10.1177/0269215507079097
[13] Gottlieb, S.S., Fisher, M.L., Freudenberger, R., et al. (1999) Effects of exercise training on peak performance and quality of life in congestive heart failure patients. Journal of Cardiac Failure, 5, 188-194. doi:10.1016/S1071-9164(99)90002-7
[14] Walsh, J.T., Andrews, R., Evans, A. and Cowley, A.J. (1995) Failure of “effective” treatment for heart failure to improve normal customary activity. British Heart Journal, 73, 373-376. doi:10.1136/hrt.74.4.373
[15] Walsh, J.T., Charlesworth, A., Andrews, R., Hawkins, M. and Cowley, A.J. (1997) Relation of daily activity levels in patients with chronic heart failure to long-term prog- nosis. American Journal of Cardiology, 79, 1364-1369. doi:10.1016/S0002-9149(97)00141-0
[16] Howell, J., Strong, B.M., Weisenberg, J., et al. (2010) Maximum daily 6 minutes of activity: An index of functional capacity derived from actigraphy and its application to older adults with heart failure. Journal of the American Geriatric Society, 58, 931-936. doi:10.1111/j.1532-5415.2010.02805.x
[17] Allison, G.-C. (2009) Principal Scientist, Medtronic Corporation.
[18] Casburi, R. (2009) Activity monitoring in assessing activities of daily living. COPD, 4, 251-255. doi:10.1080/15412550701480158
[19] Gulati, S.K., McKenzie, J., Crossley, G., Papp, M.A., Sims, J. and Andrulli, J. (2009) Device measured physical activity: Is it the new 6-minute hall walk? Journal of Cardiac Failure, 15, S119-120. doi:10.1016/j.cardfail.2009.06.055
[20] Adamson, P.B., Smith, A.L., Abraham, W.T., et al. (2004) Continuous autonomic assessment in patients with symptomatic heart failure: Prognostic value of heart rate variability measured by an implanted cardiac resynchroni- zation device. Circulation, 110, 2389-2394. doi:10.1161/01.CIR.0000139841.42454.78
[21] Small, R.S., Wickemeyer, W., Germany, R., et al. (2009) Changes in intrathoracic impedance are associated with subsequent risk of hospitalizations for acute decompenated heart failure: Clinical utility of implanted device monitoring without a patient alert. Journal of Cardiac Failure, 15, 475-481. doi:10.1016/j.cardfail.2009.01.012
[22] Jaeschke, R., Singer, J. and Guyatt, G.H. (1989) Measure of health status: Ascertaining the minimal clinically important difference. Controlled Clinical Trials, 10, 407- 415. doi:10.1016/0197-2456(89)90005-6
[23] Lydlick, E. and Epstein, R.S. (1993) Interpretation of quality of life measures. Quality of Life Research, 2, 221- 226. doi:10.1007/BF00435226
[24] Levy, W.C., Mozaffarian, D., Linker, D.T., et al. (2006) The Seattle Heart Failure Model: Prediction of survival in heart failure. Circulation, 113, 1424-1433. doi:10.1161/CIRCULATIONAHA.105.584102
[25] Beaton, D.E., Boers, M. and Wells, G.A. (2002) Many faces of the minimal clinically important difference (MCID): A literature review and directions for future re- search. Current Opinion in Rheumatology, 14, 109-114. doi:10.1097/00002281-200203000-00006
[26] HMISC: Harrell miscellaneous. http://cran.Rproject.Org/web/packages/hmisc/index.html
[27] Gorodeski, E.A., Chu, E.C., Chow, C.H., et al. (2003) Application of the Seattle Heart Failure Model in ambu-latory patients presented to an advanced heart failure therapeutics committee. Circulation and Heart Failure, 3, 706-714. doi:10.1161/CIRCHEARTFAILURE.110.944280
[28] Russell, D.S., Saval, M.A., Robbins, J.L., et al. (2009) New York Heart Association functional class predicts exercise parameters in the current era. American Heart Journal, 158, S24-S30. doi:10.1016/j.ahj.2009.07.017
[29] O’Keeffe, S.T., Lye, M., Donnellan, C. and Carmichael, D.N. (1998) Reproducibility and responsiveness of quality of life assessment and six minute walk test in elderly heart failure patients. Heart, 80, 377-382.
[30] Spertus, J., Peterson, E., Conard, M.W., et al. (2005) Monitoring clinical changes in patients with heart failure: A comparison of methods. American Heart Journal, 150, 707-715. doi:10.1016/j.ahj.2004.12.010

comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.