Everyday Activity Levels in Patients at Risk for and Patients with Heart Failure and Preserved Ejection Fraction

Elias Harnisch (Leipzig)1, P. Sagmeister (Leipzig)1, A. Schöber (Leipzig)1, K.-P. Kresoja (Leipzig)1, S. Rosch (Leipzig)1, M. Scholz (Leipzig)2, S. Henger (Leipzig)2, H. Thiele (Leipzig)1, P. Lurz (Mainz)3, K.-P. Rommel (Leipzig)1

1Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland; 2Universität Leipzig Institut für Medizinische Informatik, Statistik und Epidemiologie Leipzig, Deutschland; 3Universitätsmedizin der Johannes Gutenberg-Universität Mainz Kardiologie 1, Zentrum für Kardiologie Mainz, Deutschland


To investigate clinical characteristics associated with low daily step count in patients with elevated cardiovascular risk and Heart failure with preserved Ejection Fraction (HFpEF). 


Physical inactivity is a risk factor for and a consequence of HFpEF. Wrist worn accelerometers present a simple way to reliably measure physical activity. We hypothesized that there are varying patient characteristics associated with accelerometer measured daily step count in patients at risk for and with overt HFpEF, possibly linked to the development and perpetuation of HFpEF, respectively. 


A total of 724 patients with elevated cardiovascular risk (mean age 68 ± 9 years. 32% female) were prospectively included, underwent thorough clinical examination and were classified as having HFpEF according to ESC consensus criteria. They were then instructed to wear a wrist worn accelerometer for five consecutive days. Daily step count was adjusted for time spent awake and factors associated with a lower step count were scrutinized.


Overall, median step count was 8000 steps per day or 520 steps/hour/day. Median awake time was 15.5 hours. In comparison to higher daily step count (≥ 520 steps/h/day) patients with lower daily step count (< 520 steps/h/day) were older, had a higher BMI and body fat mass, higher white blood cell count, higher NYHA-Score and were more likely to have HFpEF, diabetes and other cardiovascular diseases (p<0.01 for all). They were also more likely to have a higher CRP, NTproBNP, eGFR and HBA1C (p<0.01 for all). Additionally, they showed slightly lower biventricular systolic function, more left ventricular (LV) diastolic dysfunction, smaller LV dimensions and more pulmonary hypertension (p<0.05 for all).
142 patients (19%) were identified as HFpEF, who showed an elevated HFAPEFF score, the latter of which was also independently associated with a lower stepcount. (β: -0.15, p<0.01). Age, body fat mass and the physical component of the SF12 quality of life score (p<0.05 for all) were independently associated with step count on multivariate stepwise linear regression in the overall cohort, as well as patients with and without overt HFpEF.
Within HFpEF Patients the strongest associations with physical activity were evident for echocardiographic parameters describing right ventricular function (TAPSE; β: 0.15, p=0.03), left ventricular diastolic function (e’ septal; β: 0.16, p= 0.02) and insulin dependent diabetes (β: -0.30, p<0.01). Within patients at risk for HFpEF left ventricular end diastolic volume (LVEDV: β: 0.15, p<0.001), as well as white blood cell count (β: -0.12, p<0.01) were associated with the step count. 


HFpEF is associated with decreased daily activity, impacting quality of life. A diminished step count is primarily linked to impaired cardiac function in HFpEF patients. Low-grade inflammation and smaller left ventricular dimensions are factors in individuals at risk for heart failure. These findings suggest varying contributors to exercise intolerance across disease stages, offering insights for tailored therapeutic approaches.

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