Safety and Efficacy of an Early Home-Based Walking Program After Receipt of an Initial Implantable Cardioverter-Defibrillator.

Abstract

To assess the safety and efficacy of an early home-based walking program for first-time implantable cardioverter-defibrillator (ICD) recipients. Pre-post intervention trial. Institutional and private practice. Cardiac patients (N=301) with an initial ICD implantation for primary or secondary prevention; able to read, speak, and write English; and having access to telephone. Early home-based walking protocol implemented 1-month post-ICD implant. Exercise tolerance monitored by study nurses via telephone. Safety assessment was based on the frequency of ICD therapies and hospitalizations, and efficacy assessment was based on pedometer measures and self-report of ICD self-efficacy and physical activity. ICD recipients were on average 64.1±11.9 years old, predominantly men, and white, with an ejection fraction of <35% and a mean Charlson comorbidity score of 2.3±1.5. Nineteen individuals (6.3%) received 28 ICD shocks; 15 (53.6%) were appropriate and 13 (46.4%) inappropriate. Antitachycardia pacing therapies were delivered 72 times in 18 individuals (6%), with 61 (84.7%) being appropriate and 11 (15.3%) inappropriate. Five ICD shocks (2 appropriate and 3 inappropriate) and 2 antitachycardia pacing therapies occurred during walking. Five participants (2%) were hospitalized for an ICD shock, none of which was associated with walking. Average steps per day increased by 806 over 3 months. Perceived exercise self-efficacy improved significantly as did weekly exercise. Predictors of receiving any ICD shock were younger age (P<.0001), moderate to severe renal disease (P=.001), and lymphoma (P=.024). Early ambulation after an initial ICD was safe and effective, with few ICD shocks and improved efficacy.