Daily Dose: More Steps a Day Linked to Better Health for Patients with Heart Failure

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on a study published in JACC: Heart Failure that examined the relationship between smartwatch activity and patient-centered outcomes in patients with heart failure (HF).

The study

Researchers conducted a subanalysis of Fitbit data from the CHIEF-HF (Canagliflozin: Impact on Health Status, Quality of Life and Functional Status in Heart Failure) trial.

Patient recruitment (N=425; mean age, 63.5 years; 83.3% White) took place from March 26, 2020, to February 12, 2021, at 18 medical centers in the US, with HF confirmed via primary diagnosis or at least 2 medical visits with a diagnostic code for HF. If a patient had a left ventricular ejection fraction above 40%, they had to be on either a loop diuretic or mineralocorticoid receptor antagonist. Additional inclusion criteria were the patient has a Samsung S7 Galaxy or Apple iPhone 6 or later version, can speak and read English, and had to wear a Fitbit—recording daily steps and floors climbed—for the entire study. HF with preserved ejection fraction was the dominant disease type in 59.1%.

Health status was evaluated using the Kansas City Cardiomyopathy Questionnaire (KCCQ) at 5 points: baseline/screening and 2, 4, 6, and 12 weeks. Scores of 25 points or fewer indicated poor health status and 75 to 100 points, good to excellent.

The findings

At the 2-week mark, the mean KCCQ Total Symptom (KCCQ-TS) and Physical Limitation (KCCQ-PL) scores were 62.7 (21.0) and 55.7 (21.6), respectively. By the 12-week mark, the corresponding scores had increased to 65.4 (22.2) and 60.2 (23.2). Mean step count as measured by the Fitbit, however, dropped from 4311.1 (2979.2) at baseline to 4293.8 (2865.5) by 12 weeks, while total floors climbed rose slightly, from 2.7 (3.9) to 2.9 (5.5).

An additional analysis that looked at associations between increased step count and KCCQ scores by score range (0-25, 25 to <50, 50 to <75, 75-100) at 2 weeks found positive correlations between higher step count and higher scores on the KCCQ-TS (P<.001) and KCCQ-PL.

Additional data demonstrate the following: Participants who walked 1000 steps/d had a 3.11-points (95% CI –1.05 to –5.17; P=.003) lower KCCQ-TS score vs those who walked 2000 steps/d, and those who walked 3000 steps/day had a 2.89-points (95% CI 1.04-4.73; P<.001) higher KCCQ-TS score.

Authors' commentary

"The importance of recognizing that there is an association with increasing activity and better health status (without better symptoms and less physical limitations caused by HF, they would not be able to increase their activity) but not with decreasing activity and lower health status, is one of the major findings of this study and supports further research to validate these findings.”

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