Greater Exercise Associated with Reduced Mortality Risk among AFib Patients

A new cohort of European patients with atrial fibrillation (AFib) evidences the benefit of physical activity in reducing risk of all-cause mortality and overall death.

A team of investigators, led by Marco Vitolo, MD, from various European institutions conducted an assessment of 8000-plus patients with AFib to interpret associations between physical activity and mortality outcomes among the cardiovascular-burdened population.

The findings were presented at the European Society of Cardiology (ESC) 2020 Congress this weekend.

Vitolo, of the University of Modena & Reggio Emilia in Italy, led the analysis of AFib patients previously enrolled in the ESC-European Heart Rhythm Association EURObservational Atrial Fibrillation (ESC-EHRA EORP-AF) General Long-Term Registry.

In evaluating a large cohort of the registry AFib patients, the team was required to rely on patient-reported metrics of physical activity in associating its effect on all-cause mortality risk. Physical activity was stratified on the basis of reported time spent exercising: no activity; occasional activity; regular activity; and intense activity. Investigators sought a primary outcome of all-cause death.

Among the 11,000-plus available registry patients, 8699 had an AFib diagnosis and available data on physical activity. Mean patient age was 69.1 years old, and 40.7% were female. The team included follow-up observation data in their analysis.

Patients prominently reported no physical activity (42.6%). Another 32.5% reported occasional physical activity, and 21.0% regular activity. Just 343 patients (3.9%) reported intense physical activity.

Vitolo and colleagues observed a progressively lower rate of female patients, mean age, and metrics for AFib stroke risk and major bleeding risk (per CHA2DS2 and HAS-BLED, respectively) among increasing categories of physical activity (P <.001 for all).

Vitamin K antatgonist use was also shown to decrease across the rising classes of physical activity: 53.1%; 52.2%; 44.5%; 33.9%, respectively (P <.001). Conversely, non-vitamin K OACs (NOACs) increased in use among the classes.

Investigators observed 848 (9.7%) all-cause death events over 680.6 mean days of follow-up. Based on analysis via Kaplan-Meier, they observed a progressively decreased cumulative risk for all-cause mortality based on physical activity levels.

Using a multivariable Cox regression analysis, investigators observed a lower risk of all-cause death associated with increasing levels of physical activity when adjusting for CHA2DS2, OAC use at baseline, and type of AFib (HR, 0.69; 95% CI, .59 - .81 for occasional activity; HR 0.45; 95% CI, .35 - .58 for regular activity; HR, 0.41; 95% CI, .23 - .76 for intense activity, all vs no activity).

Vitolo and colleagues found in a sensitivity analysis that regular and intense physical activity levels are inversely associated with cardiovascular death risk, with multivariable adjustment for comorbidities (HR, 0.54; 95% CI, .37 - .77).

“In a large contemporary cohort of European AFib patients, self-reported [physical activity] was found to be inversely associated with all-cause death and CV death,” they concluded.

The study, “Impact of physical activity on all-cause mortality in European patients with atrial fibrillation: a report from the ESC-EHRA EORP AF General Long-Term Registry,” was presented at ESC 2020.