Sedentary behavior and the risk of progression to stage C heart failure after acute myocardial infarction: a 5-year cohort study of stage B patients
T Kurosaki, M Ueda, K Hiroe, N Fukunaga, T OhtaAbstract
Background
In patients with stage B heart failure of American College of Cardiology/American Heart Association (ACC/AHA), prevention of progression to stage C is a primary goal. While physical activity improves prognosis in stage B patients after acute myocardial infarction (AMI), the impact of sedentary behavior (SB) on disease progression remains unclear.
Purpose
The purpose of this study was to determine the impact of sedentary time immediately after discharge on the progression to stage C in Stage B patients after AMI.
Methods
We conducted a retrospective cohort study of 118 stage B patients who underwent cardiac rehabilitation after AMI. Self-reported physical activity and SB duration on typical weekdays were assessed using the International Physical Activity Questionnaire (IPAQ) immediately after discharge. The primary outcome was progression to stage C within five years. Patients were classified into two groups based on disease progression. We compared clinical characteristics and physical activity between the groups. Cumulative event-free survival was estimated using the Kaplan-Meier method and compared using the log-rank test. To determine the independent prognostic value of SB, a Cox proportional hazards model adjusted for a propensity score was used. The propensity score was calculated based on age, sex, left ventricular ejection fraction (LVEF), handgrip strength, peak VO2, and total physical activity.
Results
During the 5-year follow-up, 26 patients (22.0%) progressed to Stage C. Patients with disease progression had significantly longer daily SB times (median 210 vs. 120 min/day, p < 0.001) and lower total physical activity (median 115.5 vs. 504 METs-min/week, p < 0.001) compared to those without. In the event group, handgrip strength and LVEF were also significantly lower. Kaplan-Meier analysis showed that Stage B patients with SB >= 180 min/day had significantly lower 5-year event-free survival compared to those with SB < 180 min/day (50.0% vs. 90.0%, p < 0.001). In the propensity score-adjusted Cox proportional hazards analysis, SB time was significantly associated with the onset of symptomatic HF (hazard ratio 1.43 per hour increase; 95% CI 1.001–1.011, p = 0.021).
Conclusion
Self-reported SB assessed using the IPAQ is known to be underestimated compared to objective measures due to recall bias and social desirability biases. However, even considering this characteristic, increased perceived sedentary behavior immediately after discharge was an independent predictor of progression to symptomatic HF in Stage B patients after AMI. Importantly, this association remained significant even after adjusting for physical activity levels and physical function. In addition to recommending physical activity, reducing sedentary behavior is crucial for preventing worsening of HF status in this population.