Daily Step Count Associated With Health Status in Heart Failure

Health status over time is nonlinearly associated with daily step count among patients with heart failure (HF), according to study findings published in JACC: Heart Failure.

Investigators aimed to characterize the cross-sectional and across time-relationship between patients’ health status and activity measured by a wearable smartwatch device.

The investigators used data from the CHIEF-HF (Canagliflozin: Impact on Health Status, Quality of Life and Functional Status in Heart Failure; ClinicalTrials.gov Identifier: NCT04252287) study. Briefly, CHIEF-HF was a randomized, controlled trial conducted from the end of March 2020 to mid-February 2021 from 18 medical centers across the US. Participants with HF completed the serial Kansas City Cardiomyopathy Questionnaires (KCCQs) and functional performance was assessed using a wearable device to test the efficacy of canagliflozin on health status.

In the current analysis, the investigators included data from 425 patients with HF (mean [SD] age, 63.5 [13.2] years; 44.5% women; 40.9% with reduced ejection fraction) and a compatible smartphone. Patients were excluded for a variety of reasons including history of diabetic ketoacidosis, type 1 diabetes, hypotension, and acute decompensated HF. Participants (83% White; 15% Black; 27.5% type 2 diabetes) completed the KCCQs through a smartphone application and were provided a Fitbit Versa 2.

Mean KCCQ-total symptom (TS) scores increased 2.5 points on average through 12 weeks and the KCCQ-physical limitation (PL) scores increased by 4.0 points through 12 weeks.

Baseline daily step count increased across the KCCQ-TS categories of scores:

• 2438 steps/d for scores of 0 to 24
• 4004 steps/d for scores of 25 to 49
• 4260 steps/d for scores of 50 to 74
• 4871 steps/d for scores 75 to 100; P <.001

Scores similarly increased across the KCCQ-PL categories of scores (2302 steps/d for scores of 0 to 24; 5351 steps/d for scores 75 to 100; P <.001). After multivariable adjustment, this relationship remained significant for KCCQ-TS and KCCQ-PL scores.

Changes in daily step count were significantly associated with nonlinear changes in KCCQ-TS scores (P =.004) and with nonlinear changes in KCCQ-PL scores (P =.003). This nonlinear association was primarily seen with daily step counts of less than 5000 steps. Little association was found between KCCQ scores and step counts greater than 5000 steps/d.

The investigators stated that daily floors climbed was not significantly different across 25-point ranges of KCCQ-TS scores or KCCQ-PL scores, and floors climbed was associated with baseline KCCQ scores alone.

Significant study limitations include commercially available wearable devices may not be optimal for measuring functional performance in patients with HF. There is also lack of data on comorbidities and the inability to quantify external factors (ie inclement weather’s affect on step count).

“Daily step count was nonlinearly associated with health status at baseline and over time in patients with heart failure,” the investigators wrote.

Disclosure: This research (CHIEF-HF) was supported by Janssen Research & Development, LLC. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.