The covid-19 pandemic impact on daily activity and af burden in trim-af clinical trial patients

ABSTRACT

Introduction: The COVID-19 pandemic presented an unexpected intervention to examine the association between activity and AF in patients enrolled in the TRIM-AF (Targeting Risk Interventions and Metformin for AF) clinical trial, which collects daily activity and AF burden through implanted devices. Hypothesis: We tested the hypotheses that 1) daily activity reduction during the pandemic, compared to pre-pandemic matched periods, can be detected by implanted devices;and 2) activity reduction was associated with increased daily AF burden. Methods: Daily AF burden (%) and active minutes were obtained from manufacturers for 45 subjects (28 male, 17 female, mean age 69.5 years) enrolled in the TRIM-AF 2x2 randomized clinical trial of metformin and lifestyle/risk factor modification in patients with pacemakers/defibrillators (NCT03603912). We defined pre-pandemic and pandemic matched months for each subject, maintaining constancy of pre-vs post-randomization periods and fit a linear mixed model, including age, sex, and pandemic periods, to compare the pre-and during pandemic periods (Figure A).Results: Mean daily active minutes decreased during the pandemic from 148.6 to 144.4 mins (mixed model p =<1E-10). Mean daily AF burden increased during the pandemic from 6.0 to 8.3 (mixed model p= 3.7E-14). Both mean values were compared to matched pre-pandemic time after adjusting for sex, age, and race. AF burden % was associated with age (median AF burden increased by a factor of 1.06/year of age, mixed model p= 1.38E-02) as expected. AF daily duration percent was negatively correlated with the daily active minutes as seen by the Kendall's rank correlation tau is-0.037 (z =-7.6232, p-value = 2.474e-14). Conclusions: The data suggests that activity decreased and device-detected AF burden increased during the pandemic. Further analyses could compare results to historical trends within these patients.