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Updated: Oct 7, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Impact of lockdown during COVID-19 pandemic on physical activity and arrhythmia burden in heart failure patients
Jörn Schmitt1, Beate Wenzel2, Bernd Brüsehaber2
1University Hospital Giessen and Marburg, Giessen, Germany.
Insights
COVID-19 lockdown reduced physical activity and increased atrial high rate episodes in heart failure patients with cardiac resynchronization therapy. Remote monitoring revealed these changes, highlighting potential risks during restricted periods.
Area of Science:
- Cardiology
- Medical Technology
- Public Health
Background:
- COVID-19 lockdowns restricted outdoor activity, potentially worsening heart failure (HF) progression and cardiac arrhythmias.
- Cardiac resynchronization therapy (CRT) devices with remote monitoring (RM) offer continuous data on HF patient status.
Purpose of the Study:
- To assess the impact of the March/April 2020 COVID-19 lockdown on physical activity and arrhythmia burden in HF patients.
- To identify predictors of changes in remote monitoring parameters during lockdown.
Main Methods:
- Analysis of remote monitoring data from 405 heart failure patients in the BIO|STREAM.HF registry.
- Comparison of physical activity, heart rate, pacing, and arrhythmia burden before and during lockdown.
- Statistical analysis to identify significant changes and independent predictors.
Main Results:
- A significant decrease in physical activity (-6.5%) and follow-up rates (-75%) was observed during lockdown.
- Atrial high rate episode (AHRE) burden significantly increased (+17%) during the lockdown period.
- Predictors for decreased activity included higher LVEF and lower NYHA class; predictors for increased AHRE burden included atrial fibrillation history and higher BMI.
Conclusions:
- COVID-19 lockdown led to unfavorable changes in physical activity and AHRE burden in HF patients with CRT.
- Ventricular arrhythmias did not show significant changes during the lockdown period.
- Remote monitoring effectively captured these changes, underscoring its importance in managing HF patients during public health crises.
Background:
Restricted outdoor activity during COVID-19 related lockdown may accelerate heart failure (HF) progression and thereby increase cardiac arrhythmias. We analyzed the impact of March/April 2020 lockdown on physical activity and arrhythmia burden in HF patients treated with cardiac resynchronization therapy (CRT) devices with daily, automatic remote monitoring (RM) function.
Methods:
The study cohort included 405 HF patients enrolled in Observation of Clinical Routine Care for Heart Failure Patients Implanted with BIOTRONIK CRT Devices (BIO|STREAM.HF) registry in 16 countries, who had left ventricular ejection fraction (LVEF) ≤40% (mean 28.2 ± 6.6%) and NYHA class II/III/IV (47.9%/49.6%/2.5%) before CRT pacemaker/defibrillator implantation. The analyzed RM data comprised physical activity detected by accelerometer, mean heart rate and nocturnal rate, PP variability, percentage of biventricular pacing, atrial high rate episode (AHRE) burden, ventricular extrasystoles and tachyarrhythmias, defibrillator shocks, and number of implant interrogations (i.e., follow-ups). Intraindividual differences in RM parameters before (4-week period) versus during (4-week period) lockdown were tested for statistical significance and independent predictors were identified.
Results:
There was a significant relative change in activity (mean -6.5%, p < .001), AHRE burden (+17%, p = .013), and follow-up rate (-75%, p < .001) during lockdown, with no significant changes in other RM parameters. Activity decreased by ≥8 min/day in 46.5% of patients; predictors were higher LVEF, lower NYHA class, no defibrillator indication, and more activity before lockdown. AHRE burden increased by ≥17 min/day in 4.7% of patients; predictors were history of atrial fibrillation, higher LVEF, higher body mass index, and activity decrease during lockdown.
Conclusion:
Unfavorable changes in physical activity, AHRE burden, and follow-up rate were observed during lockdown, but not in ventricular arrhythmia.
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