Greater Exercise Associated with Reduced Mortality Risk among AFib Patients

August 29, 2020
Kevin Kunzmann

New cohort analyses show very few patients with atrial fibrillation exercise regularly or rigorously—which could be a detriment to their mortality risk.

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.


x