COVID-19's enduring impact: persistent physical activity decline is associated with mortality and cardiovascular hospitalization
J Strickling, P Panchal, L Zhang, Q Li, A Gehi, L Rosman, A MazzellaAbstract
Background
Public health restrictions during the COVID-19 pandemic acutely reduced physical activity (PA) worldwide. Changes in longitudinal PA trajectories associated with the pandemic and their impact on cardiovascular (CV) outcomes in cardiac patients remain unclear1-3.
Objective
To assess the effect of PA trajectory during and following the COVID-19 pandemic as measured by cardiac implantable electronic devices (CIEDs) on CV hospitalizations and mortality.
Methods
This retrospective study analyzed PA as measured by physiologic sensors from a multisite cohort of patients with CIEDs from March 2019 through July 2024. Latent class mixed models were used to identify distinct groups of patients defined by longitudinal PA trajectories, capturing different patterns of activity change over time. Kaplan-Meier survival analysis and multivariable Cox proportional hazards models analyzed the effect of PA trajectory on CV hospitalization and mortality. Given the high mortality risk in this population, Fine-Gray hazard models were employed to assess cardiovascular hospitalization while accounting for the competing risk of death.
Results
Among 3,242 patients (mean [SD] age 71.1[12.6] years, 43.4% women), three distinct PA trajectory patterns emerged with optimal class number selected by fit statistics and interpretability following COVID-19 lockdown in North Carolina (March 30, 2020): increasing activity (n=557, 17.2%), stable activity (n=2,050, 63.2%), and declining activity (n=635, 19.6%) (Figure 1). After adjusting for age, sex, device type, and medical comorbidities, declining PA after pandemic onset was associated with a higher risk of CV hospitalization (HR 1.59, 95%CI 1.39-1.82) and mortality (HR 2.54, 95%CI 2.14-3.01, both p<0.001) (Figure 2). Fine-Gray analysis demonstrated that CV hospitalization risk was robust to the competing risk of mortality (SHR 1.59, 95% CI 1.38–1.83). Patients with increasing PA had similar hazard of CV hospitalization and mortality compared to the stable PA trajectory group.
Conclusion
Persistent PA decline four years after COVID-19 onset was strongly associated with adverse cardiovascular outcomes in one in five patients with CIEDs. Continuous device-based PA monitoring can facilitate identification of high-risk patients who may benefit from targeted preventive interventionsFigure 1Figure 2