Sex Differences in Physical Activity and Its Association With Cardiac Death and All-Cause Mortality in Patients With Implantable Cardioverter-Defibrillators

Xiaoyao Li; Xiaodi Xue; Xuerong Sun; Shuang Zhao; Keping Chen; Wei Hua; Yangang Su; Jiefu Yang; Zhaoguang Liang; Wei Xu; Zeyi Li; Shu Zhang

doi:10.3389/fcvm.2020.588622

Sex Differences in Physical Activity and Its Association With Cardiac Death and All-Cause Mortality in Patients With Implantable Cardioverter-Defibrillators

Front Cardiovasc Med. 2020 Dec 14:7:588622. doi: 10.3389/fcvm.2020.588622. eCollection 2020.

Authors

Xiaoyao Li¹, Xiaodi Xue¹, Xuerong Sun¹, Shuang Zhao¹, Keping Chen¹, Wei Hua¹, Yangang Su², Jiefu Yang³, Zhaoguang Liang⁴, Wei Xu⁵, Zeyi Li¹, Shu Zhang¹

Affiliations

¹ Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
³ Department of Cardiology, Beijing Hospital, Beijing, China.
⁴ Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China.
⁵ Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing, China.

Abstract

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.

Keywords: all-cause mortality; cardiac death; implantable cadioverter defibrillators; physical activity; sex differences.