背景:射血分数保留(HFpEF)的心力衰竭是常见的,与发病率和死亡率升高相关的复杂综合征。HFpEF患者的合并症患病率很高,包括高血压,糖尿病,肥胖,这与疾病的潜在机制密切相关。通过减肥和体育锻炼改变生活方式可以改善HFpEF的风险因素和功能结果。我们试图观察日常身体活动,并确定使用活动跟踪器是否可以增强HFpEF患者的功能状态。
方法:我们在一个学术医学中心对2021年至2023年的57例HFpEF患者进行了前瞻性分析,这些患者利用Fitbit记录了一年的每日步数活动。在门诊对患者进行了评估,以进行初次就诊,随后每隔3、6和12个月进行评估,以收集生命体征。labs,体检,和功能测量,包括六分钟步行测试(6MWT)和堪萨斯城心肌病问卷-12(KCCQ-12)。使用Stata18.0使用Pearsonr相关性评估变量之间的关联。
结果:在完成研究的49名患者中,平均年龄为68.1±10.2岁,67%的患者认定为女性。平均BMI为36.4±8.6kg/m2。在每个时间间隔中,每天的步数中位数为4,113(2,517-6,520)(1-3个月),4,583(2,532-6,326)(4-6个月),和3957(2942-5982)(7-12个月)。每日步数没有统计学上的显着变化(p=0.06)。我们观察到6MWT(p=0.002)从基线(1,175(910-1,400)到12个月(1,321(1,000-1,550))的66(6-200)英尺的统计学显着增加。在所有时间点,每日步数与6MWT高度相关(1-3个月:r=.70,p<.001;4-6个月:r=.61,p<.001;7-12个月:r=.69,p<.001)。KCCQ-12总分从基线(60.1(41.7-73.4))到12个月(69.8(50-84.4))增加了6.8(-4.2-19.8)分(p=0.005)。在问卷的子类别中,我们观察到身体限制评分与每日步数呈正相关(1-3个月:r=.47,p=.001;4-6个月:r=.63,p<.001;7-12个月:r=.56,p=.001).感兴趣的,一名每天走超过15,000步的患者的身体限制得分比那些走不到一半步的患者低10-20分,并且是队列中生活质量得分最低的患者之一,反映了心力衰竭(HF)症状的主观性质。
结论:Fitbit技术为监测HFpEF患者的实时体力活动提供了一种方便的手段。利用Fitbit记录日常活动可提高该人群与健康相关的生活质量。与提高的KCCQ-12平均总分相比,我们没有观察到6MWT在一年中的临床上显著增加.我们的发现确立了每日步数作为六分钟步行距离的宝贵替代品的实用性。
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is a common, complex syndrome associated with elevated morbidity and mortality. Patients with HFpEF have a high prevalence of comorbidities, including hypertension, diabetes mellitus, and obesity, which are closely related to the underlying mechanisms of the disease. Lifestyle modification with weight loss and physical activity can improve risk factors and functional outcomes in HFpEF. We sought to observe daily physical activity and determine whether utilizing an activity tracker can enhance functional status in HFpEF patients.
METHODS: We performed a prospective analysis of 57 patients with HFpEF from 2021 to 2023 at a single academic medical center who utilized a Fitbit to record one year of daily step activity. The patients were evaluated in the ambulatory setting for an initial visit and subsequently at intervals of 3, 6, and 12 months to gather vitals, labs, physical exam, and functional measurements, including the Six-Minute Walk Test (6MWT) and Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12). Associations between variables were assessed using Pearson\'s r correlation using Stata 18.0.
RESULTS: Of the 49 patients who completed the study, the mean age was 68.1 ± 10.2 years, with 67% of patients identifying as female. The average BMI was 36.4 ± 8.6 kg/m2. Across each time interval, the median numbers of steps per day were 4,113 (2,517-6,520) (1-3 months), 4,583 (2,532-6,326) (4-6 months), and 3,957 (2,942-5,982) (7-12 months). There was no statistically significant variation in daily step count (p=0.06). We observed a statistically significant increase of 66 (6-200) feet in the 6MWT (p= 0.002) from baseline (1,175 (910-1,400)) to 12 months (1,321 (1,000-1,550)). The daily step count was highly correlated with the 6MWT across all time points (1-3 months: r= .70, p< .001; 4-6 months: r= .61, p< .001; 7-12 months: r= .69, p< .001). The total KCCQ-12 scores increased by 6.8 (-4.2-19.8) points (p=0.005) from baseline (60.1 (41.7-73.4)) to 12 months (69.8 (50-84.4)). Among the sub-categories of the questionnaire, we observed a positive correlation between physical limitation scores and daily step count (1-3 months: r= .47, p=.001; 4-6 months: r= .63, p< .001; 7-12 months: r= .56, p= .001). Of interest, one patient who was taking over 15,000 daily steps scored their physical limitation 10-20 points lower than those taking less than half the steps and had one of the lowest quality of life scores in the cohort, reflecting the subjective nature of heart failure (HF) symptoms.
CONCLUSIONS: Fitbit technology offers a convenient means to monitor real-time physical activity in patients with HFpEF. Utilizing a Fitbit to record daily step activity enhances health-related quality of life in this population. In contrast to the improved average total KCCQ-12 score, we did not observe a clinically significant increase in the 6MWT over the course of the year. Our findings establish the utility of daily step count as a valuable surrogate for six-minute walk distance.