TY - JOUR
T1 - Comparing three wearable accelerometers to measure early activity after cardiac surgery
AU - the Cardiac Surgery Mobility Working Group
AU - Brown, Charles H.
AU - Yanek, Lisa
AU - Healy, Ryan
AU - Tsay, Tiffany
AU - Di, Junrui
AU - Goeddel, Lee
AU - Young, Daniel
AU - Zipunnikov, Vadim
AU - Schrack, Jennifer
AU - Whitman, Glenn
AU - Mandal, Kaushik
AU - Madeira, Tim
AU - Grant, Michael C.
AU - Hoyer, Erik H.
N1 - Funding Information:
Funded by a Johns Hopkins inHealth Grant to C.B. (K76AG057020-01).C.B. has consulted for and received grant funding from Medtronic. J.D. reports being a doctoral student at the Johns Hopkins University while working on this paper and is now a Pfizer employee, and he has stock or stock options in Pfizer. D.Y. has a grant from the National Institutes of Health unrelated to this study. J.S. has a grant from the National Institutes of Health (paid to Johns Hopkins). All other authors reported no conflicts of interest.The authors are grateful for the support of the Clinical Research Core within the Johns Hopkins Department of Anesthesiology & Critical Care Medicine and funding from the Johns Hopkins InHealth initiative.
Funding Information:
C.B. has consulted for and received grant funding from Medtronic . J.D. reports being a doctoral student at the Johns Hopkins University while working on this paper and is now a Pfizer employee, and he has stock or stock options in Pfizer. D.Y. has a grant from the National Institutes of Health unrelated to this study. J.S. has a grant from the National Institutes of Health (paid to Johns Hopkins). All other authors reported no conflicts of interest.
Funding Information:
The authors are grateful for the support of the Clinical Research Core within the Johns Hopkins Department of Anesthesiology & Critical Care Medicine and funding from the Johns Hopkins InHealth initiative.
Publisher Copyright:
© 2022
PY - 2022/9
Y1 - 2022/9
N2 - Objective: Wearable activity monitors can provide detailed data on activity after cardiac surgery and discriminate a patient's risk for hospital-based outcomes. However, comparative data for different monitoring approaches, as well as predictive ability over clinical characteristics, are lacking. In addition, data on specific thresholds of activity are needed. The objective of this study was to compare 3 wearable activity monitors and 1 observational mobility scale in discriminating risk for 3 hospital-based outcomes, and to establish clinically relevant step thresholds. Methods: Cardiac surgery patients were enrolled between June 2016 and August 2017 in a cohort study. Postoperative activity was measured by 3 accelerometry monitors (StepWatch Ambulation Monitor, Fitbit Charge HR, and ActiGraph GT9X) and 1 nurse-based observation scale. Monitors represent a spectrum of characteristics, including wear location (ankle/wrist), output (activity counts/steps), consumer accessibility, and cost. Primary outcomes were duration of hospitalization >7 days, discharge to a nonhome location, and 30-day readmission. Results: Data were available from 193 patients (median age 67 years [interquartile range, 58-72]). All postoperative day 2 activity metrics (ie, from StepWatch, Fitbit, ActiGraph, and the observation scale) were independently associated with prolonged hospitalization and discharge to a nonhome location. Only steps as measured by StepWatch was independently associated with 30-day readmission. Overall, StepWatch provided the greatest discrimination (C-statistics 0.71-0.76 for all outcomes). Step thresholds between 250 and 500 steps/day identified between 74% and 96% of patients with any primary outcome. Conclusions: Data from wearable accelerometers provide additive value in early postoperative risk-stratification for hospital-based outcomes. These results both support and provide guidance for activity-monitoring programs after cardiac surgery.
AB - Objective: Wearable activity monitors can provide detailed data on activity after cardiac surgery and discriminate a patient's risk for hospital-based outcomes. However, comparative data for different monitoring approaches, as well as predictive ability over clinical characteristics, are lacking. In addition, data on specific thresholds of activity are needed. The objective of this study was to compare 3 wearable activity monitors and 1 observational mobility scale in discriminating risk for 3 hospital-based outcomes, and to establish clinically relevant step thresholds. Methods: Cardiac surgery patients were enrolled between June 2016 and August 2017 in a cohort study. Postoperative activity was measured by 3 accelerometry monitors (StepWatch Ambulation Monitor, Fitbit Charge HR, and ActiGraph GT9X) and 1 nurse-based observation scale. Monitors represent a spectrum of characteristics, including wear location (ankle/wrist), output (activity counts/steps), consumer accessibility, and cost. Primary outcomes were duration of hospitalization >7 days, discharge to a nonhome location, and 30-day readmission. Results: Data were available from 193 patients (median age 67 years [interquartile range, 58-72]). All postoperative day 2 activity metrics (ie, from StepWatch, Fitbit, ActiGraph, and the observation scale) were independently associated with prolonged hospitalization and discharge to a nonhome location. Only steps as measured by StepWatch was independently associated with 30-day readmission. Overall, StepWatch provided the greatest discrimination (C-statistics 0.71-0.76 for all outcomes). Step thresholds between 250 and 500 steps/day identified between 74% and 96% of patients with any primary outcome. Conclusions: Data from wearable accelerometers provide additive value in early postoperative risk-stratification for hospital-based outcomes. These results both support and provide guidance for activity-monitoring programs after cardiac surgery.
KW - accelerometers
KW - activity and mobility
KW - cardiac surgery
KW - critical care
KW - functional status
KW - older adults
KW - physical therapy
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U2 - 10.1016/j.xjon.2022.05.011
DO - 10.1016/j.xjon.2022.05.011
M3 - Article
C2 - 36172447
AN - SCOPUS:85133794652
SN - 2666-2736
VL - 11
SP - 176
EP - 191
JO - JTCVS Open
JF - JTCVS Open
ER -