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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 7days (n=22). The median wear time required for a valid day was 600min, 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.

Kompletni atrioventrikularni (AV) blokada představuje vzacnou, avsak život ohrožujici komplikaci tyreotoxikozy. V literatuře bylo dosud popsano pouze několik připadů s nejistou kauzalni souvislosti s hypertyroidnim stavem. Vzhledem k nedostatku udajů nepanuje absolutni shoda ohledně reverzibility teto abnormality AV převodu, a tedy i nutnosti implantace trvaleho kardiostimulatoru. V nasi kazuistice popisujeme připad 35lete pacientky, u ktere se nově diagnostikovana Gravesova-Basedowova tyreotoxikoza poprve manifestovala synkopou při kompletni AV blokadě. V uvodu hospitalizace doslo ke spontanni obnově AV převodu v poměru 1 : 1, což vedlo k výrazne sinusove tachykardii s frekvenci 150/min, ktera byla symptomaticka bolestmi na hrudi, prekolapsovým stavem a vedla k rozvoji srdecniho selhani v důsledku hyperkineticke cirkulace. Dalsi komplikaci byla epizoda asystolie při recidivě uplne AV blokady bez nahradniho rytmu s nutnosti dvouminutove kardiopulmonalni resuscitace a emergentni docasne transvenozni kardiostimulace. Při lecbě tyreostatiky a kortikosteroidy se po 48 hodinach stabilizoval srdecni rytmus se sklonem k sinusove tachykardii. Dalsi průběh byl již nekomplikovaný, vcetně dobre tolerance lecby beta-blokatorem. Komplexni vysetřeni (vcetně magneticke rezonance srdce) neprokazalo žadnou jinou přicinu vysvětlujici kompletni AV blokadu. Zvažovanou implantaci trvaleho kardiostimulatoru pacientka odmitla. V nasledujicich třech měsicich sledovani již nebyla recidiva AV blokady zaznamenana. © 2019, CKS.

Aim. Understanding cardiac electronic device infective endocarditis epidemiology is essential for the management of this serious complication. Only monocentric and limited data have been published regarding patients in the Czech republic so far. The aim of this study was to describe the current profile, microbiology and clinical characteristics of this population. Patients and Methods. National data from the prospective ESC-EORP EURO-ENDO registry were collected. 57 consecutive patients with a diagnosis of cardiac device-related infective endocarditis (CDRIE) from 11 Czech centres were included. Results. Staphylococcus spp. was responsible for 43.9% of isolates, whereas Culture negative endocarditis was documented in 26.3% episodes. The most frequent complications under therapy were acute renal failure (17.5%), septic shock and heart failure (both 10.5%). Extraction of device was performed in 75.4% of all patients, and the 1-year mortality was 22.5%. Conclusions. The high proportion of culture-negative endocarditis is alarming and warrants further investigation. Cardiac device related infective endocarditis is a serious complication with a high 1-year mortality in a highly polymorbid spectrum of patients.

BackgroundRegular physical activity is recommended for patients with chronic heart failure to improve their functional capacity, and walking is a popular, effective, and safe form of physical activity. Pedometers have shown potential to increase the amount of walking across a range of chronic diseases, but it is unknown whether a pedometer-based intervention improves functional capacity and neurohumoral modulation in heart failure patients.MethodsTwo multicenter randomized controlled trials will be conducted in parallel: one in patients with chronic heart failure with reduced ejection fraction (HFrEF), the other in patients with chronic heart failure with preserved ejection fraction (HFpEF). Each trial will consist of a 6-month intervention with an assessment at baseline, at 3 months, at the end of the intervention, and 6 months after completing the intervention. Each trial will aim to include a total of 200 physically inactive participants with chronic heart failure who will be randomly assigned to intervention or control arms. The 6-month intervention will consist of an individualized pedometer-based walking program with weekly step goals, behavioral face-to-face sessions with a physician, and regular telephone calls with a research nurse. The intervention will be based on effective behavioral principles (goal setting, self-monitoring, personalized feedback). The primary outcome is the change in 6-min walk distance at the end of the 6-month intervention. Secondary outcomes include changes in serum biomarkers levels, pulmonary congestion assessed by ultrasound, average daily step count measured by accelerometry, anthropometric measures, symptoms of depression, health-related quality of life, self-efficacy, and MAGGIC risk score.DiscussionTo our knowledge, these are the first studies to evaluate a pedometer-based walking intervention in patients with chronic heart failure with either reduced or preserved ejection fraction. The studies will contribute to a better understanding of physical activity promotion in heart failure patients to inform future physical activity recommendations and heart failure guidelines.Trial registrationThe trials are registered in ClinicalTrials.gov, identifiers: NCT03041610, registered 29 January 2017 (HFrEF), NCT03041376, registered 1 February 2017 (HFpEF)