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John Molvin


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Physical Inactivity Is Associated With Post-discharge Mortality and Re-hospitalization Risk Among Swedish Heart Failure Patients : —The HARVEST-Malmö Study


  • Amir Zaghi
  • Hannes Holm
  • Johan Korduner
  • Anna Dieden
  • John Molvin
  • Erasmus Bachus
  • Amra Jujic
  • Martin Magnusson

Summary, in English

Background: Several studies have examined the role of physical activity as a predictor of heart failure (HF) mortality and morbidity. Here, we aimed to evaluate the role of self-reported physical activity as an independent risk factor of post-discharge mortality and re-hospitalization in patients hospitalized for HF, as well as study the association between physical activity and 92 plasma proteins associated with cardiovascular disease (CVD).

Methods: Four-hundred-and-thirty-four patients hospitalized for HF (mean age 75 years; 32% women) were screened for physical activity derived from questionnaires in the Swedish national public health survey. The median follow-up time to death and re-hospitalization was 835 (interquartile range, 390–1,432) and 157 (43–583) days, respectively. Associations between baseline reported physical activity, mortality and re-hospitalization risk were analyzed using multivariable Cox regression analysis. Plasma samples from 295 study participants were analyzed with a proximity extension assay consisting of 92 proteins. Associations between proteins and physical activity were explored using a false discovery rate of <5%, and significant associations were taken forward to multivariate analyses.

Results: In the multivariate Cox regression model, physical inactivity, defined as physical activity time <1 h throughout the week was associated with increased risk of all-cause mortality (HR 1.71; CI95% 1.26–2.31; p = 5.9 × 10−4) as well as all-cause re-hospitalization (HR 1.27; CI95% 1.01–1.60; p = 0.038). Further, physical inactivity was associated with elevated plasma levels of Metalloproteinase inhibitor 4, Soluble interleukin 1 receptor-like 1, Elafin and Transferrin receptor protein 1, which are implicated in myocardial fibrosis, migration and apoptosis.

Conclusions: Self-reported low weekly physical activity is associated with increased risk of mortality and re-hospitalization in patients hospitalized for HF independent of traditional risk factors. Furthermore, physical inactivity was associated with elevated levels of 4 proteins linked to cardiovascular disease.


  • Cardiovascular Research - Hypertension
  • Department of Clinical Sciences, Malmö
  • Internal Medicine - Epidemiology
  • EXODIAB: Excellence of Diabetes Research in Sweden
  • WCMM-Wallenberg Centre for Molecular Medicine
  • EpiHealth: Epidemiology for Health

Publishing year





Frontiers in Cardiovascular Medicine



Document type

Journal article


Frontiers Media S. A.


  • Cardiac and Cardiovascular Systems


  • heart failure
  • cardiac rehabilitation
  • biomarkers
  • physical activity
  • risk factor




  • The impact of physical activity in heart failure prognosis and for cardiac function

Research group

  • Cardiovascular Research - Hypertension
  • Internal Medicine - Epidemiology


  • ISSN: 2297-055X