Benefit of exercise therapy for systolic heart failure in relation to disease severity and etiology-findings from the Heart Failure and A Controlled Trial Investigating Outcomes of Exercise Training study

David J. Whellan*, Anil Nigam, Malcolm Arnold, Aijing Z. Starr, James Hill, Gerald Fletcher, Stephen J. Ellis, Lawton Cooper, Anekwe Onwuanyi, Bleakley Chandler, Steven J. Keteyian, Greg Ewald, Andrew Kao, Mihai Gheorghiade

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Background: This post hoc analysis of the HF-ACTION cohort explores the primary and secondary results of the HF-ACTION study by etiology and severity of illness. Methods: HF-ACTION randomized stable outpatients with reduced left ventricular (LV) function and heart failure (HF) symptoms to either supervised exercise training plus usual care or to usual care alone. The primary outcome was all-cause mortality or all-cause hospitalization; secondary outcomes included all-cause mortality, cardiovascular mortality or cardiovascular hospitalization, and cardiovascular mortality or HF hospitalization. The interaction between treatment and risk variable, etiology or severity as determined by risk score, New York Heart Association class, and duration of cardiopulmonary exercise test was examined in a Cox proportional hazards model for all clinical end points. Results: There was no interaction between etiology and treatment for the primary outcome (P =.73), cardiovascular (CV) mortality or CV hospitalization (P =.59), or CV mortality or HF hospitalization (P =.07). There was a significant interaction between etiology and treatment for the outcome of mortality (P =.03), but the interaction was no longer significant when adjusted for HF-ACTION adjustment model predictors (P =.08). There was no significant interaction between treatment effect and severity, except a significant interaction between cardiopulmonary exercise duration and training was identified for the primary outcome of all-cause mortality or all-cause hospitalization. Conclusion: Consideration of symptomatic (New York Heart Association classes II to IV) patients with HF with reduced LV function for participation in an exercise training program should be made independent of the cause of HF or the severity of the symptoms.

Original languageEnglish (US)
Pages (from-to)1003-1010
Number of pages8
JournalAmerican heart journal
Volume162
Issue number6
DOIs
StatePublished - Dec 2011

Funding

A complete description of the study design and ET protocol has been published previously. 7 In brief, HF-ACTION was a multicenter, randomized controlled trial designed to test the long-term safety and efficacy of aerobic ET plus evidence-based medical therapy versus UC with evidence-based medical therapy alone in medically stable outpatients with LV dysfunction (ejection fraction ≤35%) and NYHA classes II to IV HF. The relevant institutional review boards, research ethics boards, and ethics committees of the participating centers approved the study, and the coordinating center approved the protocol. An independent data safety monitoring board appointed by the trial sponsor, the National Heart, Lung, and Blood Institute, reviewed the protocol. All participants signed informed consent. The study and this analysis were funded by the National Heart, Lung, and Blood Institute.

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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