Key result
Male ICD/CRT-D patients linked to ~395% higher cardiac death risk than females between specific activity cut-offs.
Why the study?
The impact of sex on physical activity levels and its association with cardiac death and all-cause mortality in patients with ICD/CRT-D needed clarification.
Does baseline physical activity level predict cardiac death and all-cause mortality differently in male versus female patients with ICD/CRT-D?
Cohort (n=820)
Yes
Does baseline physical activity level predict cardiac death and all-cause mortality differently in male versus female patients with ICD/CRT-D?
Effect estimate: HR 4.952 (95% CI 1.055-23.245)
p-value: p=0.043
Male patients with ICD/CRT-D have higher baseline physical activity levels and higher predictive cut-off values for mortality than females, suggesting sex-specific physical activity targets are needed.
Sex-specific PA thresholds may stratify cardiac death risk differently by sex in ICD/CRT-D patients; hypothesis-generating, should not yet change practice.
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.
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Li et al. (2020) conducted a cohort in Implantable Cardioverter-Defibrillators (ICD/CRT-D) (n=820). Male sex (at physical activity levels between 7.15% and 11.16%) vs. Female sex was evaluated on Cardiac death (HR 4.952, 95% CI 1.055-23.245, p=0.043). At physical activity levels between the sex-specific cut-off values, male patients with ICD/CRT-D had a significantly higher risk of cardiac death compared to females (HR 4.952).
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