The impact of pacemaker on activity independence in heart failure: a comparative analysis of physical performance measures

Abstract Background One of the fundamental measures of functioning, the ability to perform activities of daily living (ADL), is recognized to be compromised in people with heart failure (HF). However, it is unknown, how ADL performance changes in HF patients with pacemaker, a life-saving device, how the pacemaker impacts ADL performance. Purpose This study aimed to investigate the variations in ADL performance among patients with HF who have pacemakers, those with HF without pacemakers, and healthy controls, as well as the factors influencing ADL performance. Method The study was conducted on a sample of 60 participants, consisting of 20 individuals with HF with pacemakers, 20 individuals with HF without pacemakers, and 20 healthy volunteers. All participants completed the The Glittre activity of daily living test (TGlittre) to assess ADL performance, the handgrip strength test to evaluate peripheral muscle strength, the timed up and go (TUG) test for lower extremity physical performance, and the one-minute sit-to-stand (1-STS) test to measure functional capacity. The one-way ANOVA was employed to compare physical performance outcomes among groups, while multiple linear regression analysis was utilized to identify the determinants influencing ADL. Statistical analyses were conducted utilizing SPSS version 22.0, with p0.05 deemed statistically significant. Results The distributions of age, sex, and body mass index (BMI) were comparable among the groups. The ejection fraction in pacemaker and non-pacemaker individuals was 27.9±7.38% and 39±5.56%, respectively, while the New York Heart Association functional class (FC) distribution was 55% FCII and 45% FCIII for pacemaker participants, and 70% FCII and 30% FCIII for non-pacemaker participants. TGlittre and TUG times were higher in both the pacemaker and non-pacemaker groups compared to the control group, although were comparable between the pacemaker and non- pacemaker groups. The number of 1-STS repetition was reduced in both the pacemaker and non-pacemaker groups compared to the control group, with no significant difference observed between the pacemaker and non-pacemaker groups (Table 1). The model comprising age, BMI, pacemaker presence, 1-STS, handgrip strength, and TUG variables explained 69% of the variation in TGlittre test time. The model built that the pacemaker presence, 1-STS, hand grip strength, and TUG serve as independent predictors of the TGlittre score, with the pacemaker presence was the most significant predictor of the TGlittre time (Table 2). Conclusion A pacemaker is a significant contributing factor to the decline in ADL performance, even though there is no difference in physical performance measures between individuals with HF who have a pacemaker and individuals without one. These results suggest the necessity of commencing cardiac rehabilitation in the early stages to avert the decline of ADL performance in the long term in individuals with HF who own a pacemaker.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.