Background The COVID-19 pandemic forced several European governments to impose severe lockdown measures. The reduction of physical activity during the lockdown could have been deleterious. Objective The aim of this observational, retrospective study was to investigate the effect of the lockdown strategy on the physical activity burden and subsequent reassessment in a group of patients with heart failure who were followed by means of remote monitoring. Methods We analyzed remote monitoring transmissions during the 3-month period immediately preceding the lockdown, 69 days of lockdown, and 3-month period after the first lockdown in a cohort of patients with heart failure from a general hospital in Lombardy, Italy. We compared variation of daily physical activity measured by cardiac implantable electrical devices with clinical variables collected in a hospital database. Results We enrolled 41 patients with heart failure that sent 176 transmissions. Physical activity decreased during the lockdown period (mean 3.4, SD 1.9 vs mean 2.9, SD 1.8 hours/day; P<.001) but no significant difference was found when comparing the period preceding and following the lockdown (–0.0007 hours/day; P=.99). We found a significant correlation between physical activity reduction during and after the lockdown (R2=0.45, P<.001). The only significant predictor of exercise variation in the postlockdown period was the lockdown to prelockdown physical activity ratio. Conclusions An excessive reduction of exercise in patients with heart failure decreased the tolerance to exercise, especially in patients with more comorbidities. Remote monitoring demonstrated exercise reduction, suggesting its potential utility to encourage patients to maintain their usual physical activity levels.

BACKGROUND The COVID-19 pandemic forced several European governments to impose severe lockdown measures. The reduction of physical activity during the lockdown could have been deleterious. OBJECTIVE The aim of this observational, retrospective study was to investigate the effect of the lockdown strategy on the physical activity burden and subsequent reassessment in a group of patients with heart failure who were followed by means of remote monitoring. METHODS We analyzed remote monitoring transmissions during the 3-month period immediately preceding the lockdown, 69 days of lockdown, and 3-month period after the first lockdown in a cohort of patients with heart failure from a general hospital in Lombardy, Italy. We compared variation of daily physical activity measured by cardiac implantable electrical devices with clinical variables collected in a hospital database. RESULTS We enrolled 41 patients with heart failure that sent 176 transmissions. Physical activity decreased during the lockdown period (mean 3.4, SD 1.9 vs mean 2.9, SD 1.8 hours/day; <i>P</i>&lt;.001) but no significant difference was found when comparing the period preceding and following the lockdown (–0.0007 hours/day; <i>P</i>=.99). We found a significant correlation between physical activity reduction during and after the lockdown (<i>R²</i>=0.45, <i>P</i>&lt;.001). The only significant predictor of exercise variation in the postlockdown period was the lockdown to prelockdown physical activity ratio. CONCLUSIONS An excessive reduction of exercise in patients with heart failure decreased the tolerance to exercise, especially in patients with more comorbidities. Remote monitoring demonstrated exercise reduction, suggesting its potential utility to encourage patients to maintain their usual physical activity levels.

Funding Acknowledgements Type of funding sources: None. Background Predicting worsening heart failure (WHF) events in chronic heart failure (HF) patients is important to avoid hospitalizations. In patients implanted with cardiac implantable electronic devices (CIEDs) remote monitoring may help to identify patients at risk of WHF thanks to the ability to monitor physiological parameters that may change before WHF. However, clinicians need to know patient HF-related signs, symptoms and therapy non-compliance to determine type and time of necessary interventions. A patient Smartphone Application (App) may be an ideal option to remotely collect this information from patients and help clinicians in the decision-making process. Purpose to assess the penetration of App technology in a large real-world HF population and to evaluate patient willingness and compliance to use a HF-dedicated App to weekly send a diary on HF signs, symptoms and therapy compliance to the cardiologist. Methods From January 2021 to July 2022, 10 Italian hospitals in the framework of the One Hospital ClinicalService project designed a questionnaire on the use of App technology and submitted it to their HF patients with CIED during scheduled in-hospital follow-up. If the patient or his caregiver was able and willing to use Apps, the HF-dedicated App was activated on his smartphone. Compliance in using the App (= percentage of weeks in a year with at list an App diary received by all patients) was evaluated for patients who have received it for at least one year. Results 495 HF patients with CIED (age 67±13 years, 79% males, 26% NYHA III-IV, LVEF 35±11%, 60% with 3-chamber CIED, 43% with high school qualification) completed the questionnaire. Out of them, 80% have access to App technology, directly or through a caregiver; ≥62% can do all high-level activities (APP installation, email, web browsing) and 21% has already used Health Apps; 73% is willing to weekly send a diary using the App. 311 patients (63% of respondents) downloaded the HF-dedicated App on their or caregiver’s smartphone. They were younger and with higher school qualification than those not receiving the App. No other difference in baseline characteristics was seen. 138 patients have received the App for at least 1 year. Their compliance decreased during time, from 60% (weeks 1-13) to 42% (weeks 40-52; p &lt;.001). Patients aging ≥ 60 years had a higher mean yearly compliance (53%) than younger patients (42%; p &lt;.001; Fig. 1). Hospitals with dedicated staff to remote monitoring achieved a higher mean yearly patient compliance (64%) than other sites (33%, p &lt;.001). Conclusion In a large real-world HF population with CIED patients, the penetration of Smartphone technology was high and &gt; 60-year-old patients had higher compliance to the use of a new HF-dedicated App compared to younger patients. The use of Smartphone App technology to collect WHF sign/symptoms is feasible and may improve remote management of HF patients.