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Physical activity among patients with cardiovascular disease: a predictor of hospital care utilisation and mortality in clinical work
Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.ORCID iD: 0000-0001-9833-8306
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Guidelines highlight the importance of physical activity (PA) in secondary prevention of cardiovascular disease (CVD) within the healthcare sector. Previous studies have mainly focused on the effects of PA at moderate-vigorous intensity performed within exercise-based cardiac rehabilitation (CR). However, only a minority of patients with CVD participate in exercise-based CR, and it is not known to what extent the guidelines for PA are implemented in clinical work. This leads to a knowledge gap in PA levels among patients with CVD, and the potential association of PA with hospital care utilisation and all-cause mortality. The overall aim of this thesis was to investigate PA and its importance for patients with CVD, and to what extent it is promoted during clinical work. The associations between self-rated PA level, changes in self-rated PA level, and sedentary time (SED) with hospital care utilisation and all-cause mortality were explored in three cohort studies (Studies I-III). Data were collected via questionnaires, medical records and national registers. Study I explored everyday PA, physical exercise and SED among patients with CVD (n=1148) prior to admittance to a cardiac ward at two of the hospitals in Stockholm. Studies II and III explored PA (of at least moderate intensity) post hospitalisation, and included 30 644 and 22 227 patients with myocardial infarction (MI), respectively, from the national SWEDHEART registry. Finally, in Study IV, healthcare professionals’ (n=251) stated importance and clinical work to promote healthy lifestyle habits (alcohol consumption, eating habits, physical activity, and smoking) were explored in a cross-sectional study. All healthcare professionals working on cardiac departments in two hospitals in Stockholm were included.

The main findings were:

• PA level (everyday PA, physical exercise, total PA level) and SED pre and post hospitalisation for cardiac events were found to be significant predictors of hospital care duration, readmission and mortality. The effects of high PA level and low SED did not differ between CVD diagnosis, sex, age, or comorbid states such as individuals with and without diabetes mellitus type II, kidney dysfunction, hypertension or dyslipidaemia.

• There were no differences between individuals reporting a moderate or high level of PA or a medium or low level of SED, illustrating that “a little activity is better than nothing” and that the greatest health benefits would be achieved by increasing PA among the most inactive patients with CVD.

• Changes in PA level during the first year post MI are important. Increased PA lowered the risk of mortality, and decreased PA increased the risk of mortality in patients post MI.

• Healthcare professionals considered it important to promote lifestyle habits among patients within the healthcare sector in general, as well as in their own clinical work. However, there was a difference between stated importance and clinical practice as only a minority of healthcare professionals asked or provided counselling on healthy lifestyle habits. Our results indicated a relationship between promoting patients’ lifestyle habits in clinical work, and if they perceived clear organisational routines and objectives.

In conclusion, the results of this thesis have a clinical impact. Firstly, asking patients on a cardiac department about their PA level and SED may identify individuals in need of behavioural changes. By identifying and supporting individuals who need to increase their PA level, clinicians may potentially decrease the utilisation of inpatient care and also lower the risk of all-cause mortality among individuals with a CVD diagnosis. Secondly, this information is of great predictive value, and PA can be seen as an additional marker of disease severity.

Place, publisher, year, edition, pages
Stockholm: Gymnastik och Idrottshögskolan, GIH , 2020. , p. 108
Series
Avhandlingsserie för Gymnastik- och idrottshögskolan ; 17
Keywords [en]
Cardiovascular disease, Physical exercise, Sedentary behaviour, Physical activity, Survival, Mortality, Hospitalisation, Cardiology Service, Guideline adherence
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy Sport and Fitness Sciences
Research subject
Medicine/Technology
Identifiers
URN: urn:nbn:se:gih:diva-5970ISBN: 978-91-983151-8-9 (print)OAI: oai:DiVA.org:gih-5970DiVA, id: diva2:1381251
Public defence
2020-02-07, Aulan, Lidingövägen 1, Box 5626, Stockholm, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-12-20 Created: 2019-12-20 Last updated: 2019-12-20Bibliographically approved
List of papers
1. Predictive value of pre-hospitalisation physical activity level and sedentary time for hospital utilisation and all-cause mortality among patients with cardiovascular disease
Open this publication in new window or tab >>Predictive value of pre-hospitalisation physical activity level and sedentary time for hospital utilisation and all-cause mortality among patients with cardiovascular disease
(English)Manuscript (preprint) (Other academic)
Keywords
Hospitalisation, Physical exercise, Sedentary behaviour, Survival
National Category
Medical and Health Sciences
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5956 (URN)
Note

At the time of Amanda Ek's disertation this was a manuscript.

Available from: 2019-12-17 Created: 2019-12-17 Last updated: 2019-12-20Bibliographically approved
2. Physical inactivity and smoking after myocardial infarction as predictors for readmission and survival: results from the SWEDEHEART-registry.
Open this publication in new window or tab >>Physical inactivity and smoking after myocardial infarction as predictors for readmission and survival: results from the SWEDEHEART-registry.
Show others...
2019 (English)In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 108, no 3, p. 324-332Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Physical activity (PA) and smoking cessation are included in the secondary prevention guidelines after myocardial infarction (MI), but they are still underutilised. This study aims to explore how PA level and smoking status (6-10 weeks post-MI) were associated with 1-year readmission and mortality during full follow-up time, and with the cumulative 5-year mortality.

METHODS: A population-based cohort of all hospitals providing MI-care in Sweden (SWEDEHEART-registry) in 2004-2014. PA was expressed as the number of exercise sessions of ≥ 30 min in the last 7 days: 0-1 (low), 2-4 (medium) and 5-7 (high) sessions/week. Individuals were categorised as smokers, former smokers or never-smokers. The associations were analysed by unadjusted and adjusted logistic and Cox regressions.

RESULTS: During follow-up (M = 3.58 years), a total of 1702 deaths occurred among 30 644 individuals (14.1 cases per 1000 person-years). For medium and high PA, the hazard ratios (HRs) for mortality were 0.39 and 0.36, respectively, compared with low PA. For never-smokers, the HR was 0.45 and former smokers 0.56 compared with smokers. Compared with low PA, the odds ratios (ORs) for readmission in medium PA were 0.65 and 0.59 for CVD and non-CVD causes, respectively. For high PA, the corresponding ORs were 0.63 and 0.55. The association remained in adjusted models. There were no associations between smoking status and readmission.

CONCLUSIONS: The PA level and smoking status are strong predictors of mortality post-MI and the PA level also predicts readmission, highlighting the importance of adherence to the secondary prevention guidelines.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Hospitalisation, Myocardial ischaemia, Physical activity, Survival, Tobacco
National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5405 (URN)10.1007/s00392-018-1360-x (DOI)000459158700012 ()30167806 (PubMedID)
Available from: 2018-09-04 Created: 2018-09-04 Last updated: 2019-12-20
3. Increased Physical Activity Post-Myocardial Infarction Is Related to Reduced Mortality; Results From the SWEDEHEART Registry
Open this publication in new window or tab >>Increased Physical Activity Post-Myocardial Infarction Is Related to Reduced Mortality; Results From the SWEDEHEART Registry
Show others...
2018 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 24, article id e010108Article in journal (Refereed) Published
Abstract [en]

Background

With increasing survival rates among patients with myocardial infarction (MI), more demands are placed on secondary prevention. While physical activity (PA) efforts to obtain a sufficient PA level are part of secondary preventive recommendations, it is still underutilized. Importantly, the effect of changes in PA after MI is largely unknown. Therefore, we sought to investigate the effect on survival from changes in PA level, post‐MI.

Methods and Results

Data from Swedish national registries were combined, totaling 22 227 patients with MI. PA level was self‐reported at 6 to 10 weeks post‐MI and 10 to 12 months post‐MI. Patients were classified as constantly inactive, increased activity, reduced activity, and constantly active. Proportional hazard ratios were calculated. During 100 502 person‐years of follow‐up (mean follow‐up time 4.2 years), a total of 1087 deaths were recorded. Controlling for important confounders (including left ventricular function, type of MI, medication, smoking, participation in cardiac rehabilitation program, quality of life, and estimated kidney function), we found lower mortality rates among constantly active (hazard ratio: 0.29, 95% confidence interval: 0.21–0.41), those with increased activity (0.41, 95% confidence interval: 0.31–0.55), and those with reduced activity (hazard ratio: 0.56, 95% confidence interval: 0.45–0.69) during the first year post‐MI, compared with those being constantly inactive. Stratified analyses indicated strong effect of PA level among both sexes, across age, MI type, kidney function, medication, and smoking status.

Conclusions

The present article shows that increasing the PA level, compared with staying inactive the first year post‐MI, was related to reduced mortality.

Place, publisher, year, edition, pages
American Heart Association, 2018
National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5506 (URN)10.1161/JAHA.118.010108 (DOI)000455184800009 ()30561263 (PubMedID)
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-12-20
4. The gap between stated importance of and clinical work in promoting healthy lifestyle habits, by healthcare professionals in a Swedish hospital setting: a cross-sectional survey
Open this publication in new window or tab >>The gap between stated importance of and clinical work in promoting healthy lifestyle habits, by healthcare professionals in a Swedish hospital setting: a cross-sectional survey
(English)Manuscript (preprint) (Other academic)
Keywords
Tobacco cessation; Physical activity; Eating habits; Alcohol; Cardiology Service; Guideline adherence
National Category
Medical and Health Sciences
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5955 (URN)
Note

At the time of Amanda Ek's disertation this was a manuscript

Available from: 2019-12-16 Created: 2019-12-16 Last updated: 2019-12-20Bibliographically approved

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