Can activity monitors predict outcomes in patients with heart failure? A systematic review

Tan, Melissa; Wong, Joanna; Bakrania, Kishan; Abdullahi, Yusuf; Harling, Leanne; Casula, Roberto; Rowlands, Alex V.; Athanasiou, Thanos; Jarral, Omar A.

doi:10.1093/ehjqcco/qcy038

Cited by 28 publications

(14 citation statements)

References 77 publications

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“…Studies published from the inception of the databases up to September 2019 were sought. Additionally, the reference lists of recently published reviews [5][6][7] were hand searched for further studies. Titles and abstracts of the retrieved studies were screened to identify studies that potentially meet the eligibility criteria.…”

Section: Search Strategymentioning

confidence: 99%

“…Therefore, interest in objectively assessing PA has proliferated, with accelerometers representing the most popular tool used in contemporary research. Despite this, several systematic reviews have recently reported that the quality of accelerometry‐based PA assessment is relatively poor in studies in patients with cardiovascular diseases 5–7 . As poor or inaccurate assessment of PA using accelerometry can deleteriously impact the advancement of PA research in cardiology and impede its translation into clinical practice, it is crucial that we understand how accelerometers have been used in cardiology to date.…”

Section: Introductionmentioning

confidence: 99%

“…To address this issue, we chose HF as an example of a cardiovascular disease, because of its increasing prevalence and economic burden, and because the benefits of PA for patients with HF are well established. 2,6,8 We conducted a systematic review of studies using accelerometers in HF patients with the aims (i) to explore the methods used for collecting and processing accelerometry data, (ii) to evaluate accelerometry-based metrics used for the assessment of PA, (iii) to examine the quality of reporting on data collection and processing, (iv) to review the validity of accelerometers in this population, and (v) to provide practical recommendations for researchers and clinicians on how to objectively assess PA and sedentary behaviour in patients with cardiovascular diseases using accelerometers.…”

Section: Introductionmentioning

confidence: 99%

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Advances in accelerometry for cardiovascular patients: a systematic review with practical recommendations

et al. 2020

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Aims Accelerometers are becoming increasingly commonplace for assessing physical activity; however, their use in patients with cardiovascular diseases is relatively substandard. We aimed to systematically review the methods used for collecting and processing accelerometer data in cardiology, using the example of heart failure, and to provide practical recommendations on how to improve objective physical activity assessment in patients with cardiovascular diseases by using accelerometers. Methods and results Four electronic databases were searched up to September 2019 for observational, interventional, and validation studies using accelerometers to assess physical activity in patients with heart failure. Study and population characteristics, details of accelerometry data collection and processing, and description of physical activity metrics were extracted from the eligible studies and synthesized. To assess the quality and completeness of accelerometer reporting, the studies were scored using 12 items on data collection and processing, such as the placement of accelerometer, days of data collected, and criteria for non-wear of the accelerometer. In 60 eligible studies with 3500 patients (of those, 536 were heart failure with preserved ejection fraction patients), a wide variety of accelerometer brands (n = 27) and models (n = 46) were used, with Actigraph being the most frequent (n = 12), followed by Fitbit (n = 5). The accelerometer was usually worn on the hip (n = 32), and the most prevalent wear period was 7 days (n = 22). The median wear time required for a valid day was 600 min, and between two and five valid days was required for a patient to be included in the analysis. The most common measures of physical activity were steps (n = 20), activity counts (n = 15), and time spent in moderate-to-vigorous physical activity (n = 14). Only three studies validated accelerometers in a heart failure population, showing that their accuracy deteriorates at slower speeds. Studies failed to report between one and six (median 4) of the 12 scored items, with non-wear time criteria and valid day definition being the most underreported items. Conclusions The use of accelerometers in cardiology lacks consistency and reporting on data collection, and processing methods need to be improved. Furthermore, calculating metrics based on raw acceleration and machine learning techniques is lacking, opening the opportunity for future exploration. Therefore, we encourage researchers and clinicians to improve the quality and transparency of data collection and processing by following our proposed practical recommendations for using accelerometers in patients with cardiovascular diseases, which are outlined in the article.

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Section: Search Strategymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Advances in accelerometry for cardiovascular patients: a systematic review with practical recommendations

et al. 2020

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“…Maintenance of adequate physical activity (PA) is a key lifestyle recommendation for many chronic disease populations, including heart failure (HF) patients, with benefits including improvements in exercise capacity, health-related quality-of-life and reduced all-cause and HF-specific mortality and hospital admissions [ 1 – 4 ]. Progressively, clinical trials are relying on accelerometers to objectively measure levels of PA and inactivity, to investigate the relationship between PA, inactivity and HF disease progression [ 5 ], or to evaluate the effect of a PA or exercise programme in primary or secondary prevention in HF [ 6 ]. However, there is yet to be consensus on the most appropriate way to convert raw acceleration data into behaviourally relevant metrics, particularly in chronic disease populations.…”

Section: Introductionmentioning

confidence: 99%

Physical activity assessment by accelerometry in people with heart failure

Dibben

Gandhi

Taylor

et al. 2020

BMC Sports Sci Med Rehabil

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Background: International guidelines for physical activity recommend at least 150 min per week of moderate-tovigorous physical activity (MVPA) for adults, including those with cardiac disease. There is yet to be consensus on the most appropriate way to categorise raw accelerometer data into behaviourally relevant metrics such as intensity, especially in chronic disease populations. Therefore the aim of this study was to estimate acceleration values corresponding to inactivity and MVPA during daily living activities of patients with heart failure (HF), via calibration with oxygen consumption (VO 2) and to compare these values to previously published, commonly applied PA intensity thresholds which are based on healthy adults. Methods: Twenty-two adults with HF (mean age 71 ± 14 years) undertook a range of daily living activities (including laying down, sitting, standing and walking) whilst measuring PA via wrist-and hip-worn accelerometers and VO 2 via indirect calorimetry. Raw accelerometer output was used to compute PA in units of milligravity (mg). Energy expenditure across each of the activities was converted into measured METs (VO 2 /resting metabolic rate) and standard METs (VO 2 /3.5 ml/kg/min). PA energy costs were also compared with predicted METs in the compendium of physical activities. Location specific activity intensity thresholds were established via multilevel mixed effects linear regression and receiver operator characteristic curve analysis. A leave-one-out method was used to cross-validate the thresholds. Results: Accelerometer values corresponding with intensity thresholds for inactivity (< 1.5METs) and MVPA (≥3.0METs) were > 50% lower than previously published intensity thresholds for both wrists and waist accelerometers (inactivity: 16.7 to 18.6 mg versus 45.8 mg; MVPA: 43.1 to 49.0 mg versus 93.2 to 100 mg). Measured METs were higher than both standard METs (34-35%) and predicted METs (45-105%) across all standing and walking activities. Conclusion: HF specific accelerometer intensity thresholds for inactivity and MVPA are lower than previously published thresholds based on healthy adults, due to lower resting metabolic rate and greater energy expenditure during daily living activities for HF patients. Trial registration: Clinical trials.gov NCT03659877, retrospectively registered on September 6th 2018.

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“…There is currently no gold standard for activity assessment or grading: different studies have used different measurements of physical activity (e.g. step count, device-generated arbitrary units, duration of activity) [ 29 ]. The impact of such assessments on decision-making and quality of life, or indeed on disease or illness trajectory, is unknown.…”

Section: Direct-to-consumer Devices and Their Potential Usementioning

confidence: 99%

The Role of Wearables in Heart Failure

Singhal

Cowie

2020

Curr Heart Fail Rep

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Purpose of Review This review discusses how wearable devices-sensors externally applied to the body to measure a physiological signal-can be used in heart failure (HF) care. Recent Findings Most wearables are marketed to consumers and can measure movement, heart rate, and blood pressure; detect and monitor arrhythmia; and support exercise training and rehabilitation. Wearable devices targeted at healthcare professionals include ECG patch recorders and vests, patches, and textiles with in-built sensors for improved prognostication and the early detection of acute decompensation. Integrating data from wearables into clinical decision-making has been slow due to clinical inertia and concerns regarding data security and validity, lack of evidence of meaningful impact, interoperability, regulatory and reimbursement issues, and legal liability. Summary Although few studies have assessed how best to integrate wearable technologies into clinical practice, their use is rapidly expanding and may support improved decision-making by patients and healthcare professionals along the whole patient pathway.

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Can activity monitors predict outcomes in patients with heart failure? A systematic review

Abstract: Nil.

Cited by 28 publications

References 77 publications

Advances in accelerometry for cardiovascular patients: a systematic review with practical recommendations

Advances in accelerometry for cardiovascular patients: a systematic review with practical recommendations

Physical activity assessment by accelerometry in people with heart failure

The Role of Wearables in Heart Failure

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