Abstract 11381: Low Physical Activity is Associated with Poor Prognosis and Proteins Associated with Cardiovascular Disease Among Swedish Heart Failure Patients

Abstract

Introduction: Several studies suggest that cardiac rehabilitation through physical exercise could reduce heart failure (HF) morbidity and mortality. Hypothesis: Here, we aimed to evaluate the association of physical activity with plasma levels of 92 proteins associated with cardiovascular disease (CVD) as well as risk of re-hospitalization and mortality in patients hospitalized for HF. Methods: Four-hundred-and-thirty-three patients hospitalized for HF (mean age 75 years; 32% women) were screened for physical activity derived from questionnaires in the Swedish national public health survey. The median follow-up time to death and re-hospitalization was 842 (IQR, 390-1433) and 155 (IQR, 42-583) days, respectively. Associations between baseline reported physical activity scores, mortality and re-hospitalization risk were analyzed using multivariable Cox regression analysis. Plasma samples from 295 study participants were analyzed with a proximity extension assay consisting of 92 proteins. Associations between proteins and physical activity were explored using a false discovery rate of 5%, and significant associations were taken forward to multivariate analyses. Results: A total of 206 patients (48%) reported moderate and regular physical activity throughout the week. In the fully adjusted Cox regression model, absence of moderate to regular physical activity was associated with increased mortality (HR 1.50; CI95% 1.11-2.03; p=0.008), but not with re-hospitalization risk (HR 1.05; CI95% 0.84-1.32; p=0.684). Physical active time below 1 h throughout the week was associated with increased risk of mortality (HR 1.82; CI95% 1.36-2.43; p<0.001)as well as re-hospitalization irrespective of cause (HR 1.26; CI95% 1.01-1.58; p=0.049). Sedentary lifestyle was associated with elevated plasma levels of 24 proteins, whereof several implicated in myocardial fibrosis, migration and apoptosis. Conclusions: Low weekly physical activity is associated with increased risk of mortality and re-hospitalization in hospitalized HF patients, independently of traditional risk factors. Further sedentary lifestyle was associated with elevated levels of several proteins earlier linked to myocardial fibrosis, migration and apoptosis.