Real-world walking behaviors are associated with early-stage heart failure: a Project Baseline Health Study

Sooyoon Shin; Nathan Kowahl; Taylor Hansen; Albee Y Ling; Poulami Barman; Nicholas Cauwenberghs; Erin Rainaldi; Sarah Short; Jessilyn Dunn; Md Mobashir Hasan Shandhi; Svati H Shah; Kenneth W Mahaffey; Tatiana Kuznetsova; Melissa A Daubert; Pamela S Douglas; Francois Haddad; Ritu Kapur

doi:10.1016/j.cardfail.2024.02.028

Real-world walking behaviors are associated with early-stage heart failure: a Project Baseline Health Study

J Card Fail. 2024 Apr 4:S1071-9164(24)00113-1. doi: 10.1016/j.cardfail.2024.02.028. Online ahead of print.

Authors

Sooyoon Shin¹, Nathan Kowahl², Taylor Hansen², Albee Y Ling², Poulami Barman², Nicholas Cauwenberghs³, Erin Rainaldi², Sarah Short², Jessilyn Dunn⁴, Md Mobashir Hasan Shandhi⁵, Svati H Shah⁵, Kenneth W Mahaffey⁶, Tatiana Kuznetsova³, Melissa A Daubert⁵, Pamela S Douglas⁵, Francois Haddad⁷, Ritu Kapur⁸

Affiliations

¹ Verily Life Sciences; South San Francisco, CA. Electronic address: Sooyoon@verily.com.
² Verily Life Sciences; South San Francisco, CA.
³ Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium.
⁴ Duke University Department of Biomedical Engineering; Durham, NC; Duke University Department of Biostatistics & Bioinformatics; Durham, NC; Duke Clinical Research Institute; Durham, NC.
⁵ Duke Clinical Research Institute; Durham, NC; Division of Cardiology, Duke University Medical School; Duke University; Durham, NC.
⁶ Stanford Center for Clinical Research, Department of Medicine, Stanford School of Medicine; Stanford, CA.
⁷ Stanford Center for Clinical Research, Department of Medicine, Stanford School of Medicine; Stanford, CA; Division of Cardiovascular Medicine, Department of Medicine, Stanford University; Stanford, CA; Stanford Cardiovascular Institute, Stanford University; Stanford, CA.
⁸ Verily Life Sciences; South San Francisco, CA; Department of Neurology, Radboud University Medical Center; Nijmegen, The Netherlands.

PMID: 38582256
DOI: 10.1016/j.cardfail.2024.02.028

Abstract

Background: Data collected via wearables may complement in-clinic assessments to monitor subclinical heart failure (HF).

Objectives: Evaluate the association of sensor-based digital walking measures with HF stage and characterize their correlation with in-clinic measures of physical performance, cardiac function and participant reported outcomes (PROs) in individuals with early HF.

Methods: The analyzable cohort included participants from the Project Baseline Health Study (PBHS) with HF stage 0, A, or B, or adaptive remodeling phenotype (without risk factors but with mild echocardiographic change, termed RF-/ECHO+) (based on available first-visit in-clinic test and echocardiogram results) and with sufficient sensor data. We computed daily values per participant for 18 digital walking measures, comparing HF subgroups vs stage 0 using multinomial logistic regression and characterizing associations with in-clinic measures and PROs with Spearman's correlation coefficients, adjusting all analyses for confounders.

Results: In the analyzable cohort (N=1265; 50.6% of the PBHS cohort), one standard deviation decreases in 17/18 walking measures were associated with greater likelihood for stage-B HF (multivariable-adjusted odds ratios [ORs] vs stage 0 ranging from 1.18-2.10), or A (ORs vs stage 0, 1.07-1.45), and lower likelihood for RF-/ECHO+ (ORs vs stage 0, 0.80-0.93). Peak 30-minute pace demonstrated the strongest associations with stage B (OR vs stage 0=2.10; 95% CI:1.74-2.53) and A (OR vs stage 0=1.43; 95% CI:1.23-1.66). Decreases in 13/18 measures were associated with greater likelihood for stage-B HF vs stage A. Strength of correlation with physical performance tests, echocardiographic cardiac-remodeling and dysfunction indices and PROs was greatest in stage B, then A, and lowest for 0.

Conclusions: Digital measures of walking captured by wearable sensors could complement clinic-based testing to identify and monitor pre-symptomatic HF.

Keywords: Digital biomarkers; Heart failure; subclinical heart failure fitness; walking capacity.