Exercise training and implantable cardioverter-defibrillator shocks in patients with heart failure. Results from HF-ACTION (Heart failure and a controlled trial investigating outcomes of exercise training)

Jonathan P. Piccini, Anne S. Hellkamp, David J. Whellan, Stephen J. Ellis, Steven J. Keteyian, William E. Kraus, Adrian F. Hernandez, James P. Daubert, Ileana L. Pina, Christopher M. O'Connor

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to determine whether exercise training is associated with an increased risk of implantable cardioverter-defibrillator (ICD) therapy in patients with heart failure (HF). Background: Few data are available regarding the safety of exercise training in patients with ICDs and HF. Methods: HF-ACTION (Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing) randomized 2,331 outpatients with HF and an ejection fraction (EF) ≤35% to exercise training or usual care. Cox proportional hazards modeling was used to examine the relationship between exercise training and ICD shocks. Results: We identified 1,053 patients (45%) with an ICD at baseline who were randomized to exercise training (n = 546) or usual care (n = 507). Median age was 61 years old, and median EF was 24%. Over a median of 2.2 years of follow-up, 20% (n = 108) of the exercise patients had a shock versus 22% (n = 113) of the control patients. A history of sustained ventricular tachycardia/fibrillation (hazard ratio [HR]: 1.93 [95% confidence interval (CI): 1.47 to 2.54]), previous atrial fibrillation/flutter (HR: 1.63 [95% CI: 1.22 to 2.18]), exercise-induced dysrhythmia (HR: 1.67 [95% CI: 1.23 to 2.26]), lower diastolic blood pressure (HR for 5-mm Hg decrease <60: 1.35 [95% CI: 1.12 to 1.61]), and nonwhite race (HR: 1.50 [95% CI: 1.13 to 2.00]) were associated with an increased risk of ICD shocks. Exercise training was not associated with the occurrence of ICD shocks (HR: 0.90 [95% CI: 0.69 to 1.18], p = 0.45). The presence of an ICD was not associated with the primary efficacy composite endpoint of death or hospitalization (HR: 0.99 [95% CI: 0.86 to 1.14], p = 0.90). Conclusions: We found no evidence of increased ICD shocks in patients with HF and reduced left ventricular function who underwent exercise training. Exercise therapy should not be prohibited in ICD recipients with HF. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437).

Original languageEnglish (US)
Pages (from-to)142-148
Number of pages7
JournalJACC: Heart Failure
Volume1
Issue number2
DOIs
StatePublished - Apr 2013
Externally publishedYes

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Implantable Defibrillators
Shock
Heart Failure
Exercise
Confidence Intervals
Blood Pressure
Exercise Therapy
Atrial Flutter
Ventricular Fibrillation
Ventricular Tachycardia
Left Ventricular Function
Atrial Fibrillation
Hospitalization
Outpatients
Safety
Education

Keywords

  • Arrhythmia
  • Exercise
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Exercise training and implantable cardioverter-defibrillator shocks in patients with heart failure. Results from HF-ACTION (Heart failure and a controlled trial investigating outcomes of exercise training). / Piccini, Jonathan P.; Hellkamp, Anne S.; Whellan, David J.; Ellis, Stephen J.; Keteyian, Steven J.; Kraus, William E.; Hernandez, Adrian F.; Daubert, James P.; Pina, Ileana L.; O'Connor, Christopher M.

In: JACC: Heart Failure, Vol. 1, No. 2, 04.2013, p. 142-148.

Research output: Contribution to journalArticle

Piccini, Jonathan P. ; Hellkamp, Anne S. ; Whellan, David J. ; Ellis, Stephen J. ; Keteyian, Steven J. ; Kraus, William E. ; Hernandez, Adrian F. ; Daubert, James P. ; Pina, Ileana L. ; O'Connor, Christopher M. / Exercise training and implantable cardioverter-defibrillator shocks in patients with heart failure. Results from HF-ACTION (Heart failure and a controlled trial investigating outcomes of exercise training). In: JACC: Heart Failure. 2013 ; Vol. 1, No. 2. pp. 142-148.
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abstract = "Objectives: The purpose of this study was to determine whether exercise training is associated with an increased risk of implantable cardioverter-defibrillator (ICD) therapy in patients with heart failure (HF). Background: Few data are available regarding the safety of exercise training in patients with ICDs and HF. Methods: HF-ACTION (Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing) randomized 2,331 outpatients with HF and an ejection fraction (EF) ≤35{\%} to exercise training or usual care. Cox proportional hazards modeling was used to examine the relationship between exercise training and ICD shocks. Results: We identified 1,053 patients (45{\%}) with an ICD at baseline who were randomized to exercise training (n = 546) or usual care (n = 507). Median age was 61 years old, and median EF was 24{\%}. Over a median of 2.2 years of follow-up, 20{\%} (n = 108) of the exercise patients had a shock versus 22{\%} (n = 113) of the control patients. A history of sustained ventricular tachycardia/fibrillation (hazard ratio [HR]: 1.93 [95{\%} confidence interval (CI): 1.47 to 2.54]), previous atrial fibrillation/flutter (HR: 1.63 [95{\%} CI: 1.22 to 2.18]), exercise-induced dysrhythmia (HR: 1.67 [95{\%} CI: 1.23 to 2.26]), lower diastolic blood pressure (HR for 5-mm Hg decrease <60: 1.35 [95{\%} CI: 1.12 to 1.61]), and nonwhite race (HR: 1.50 [95{\%} CI: 1.13 to 2.00]) were associated with an increased risk of ICD shocks. Exercise training was not associated with the occurrence of ICD shocks (HR: 0.90 [95{\%} CI: 0.69 to 1.18], p = 0.45). The presence of an ICD was not associated with the primary efficacy composite endpoint of death or hospitalization (HR: 0.99 [95{\%} CI: 0.86 to 1.14], p = 0.90). Conclusions: We found no evidence of increased ICD shocks in patients with HF and reduced left ventricular function who underwent exercise training. Exercise therapy should not be prohibited in ICD recipients with HF. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437).",
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AU - Whellan, David J.

AU - Ellis, Stephen J.

AU - Keteyian, Steven J.

AU - Kraus, William E.

AU - Hernandez, Adrian F.

AU - Daubert, James P.

AU - Pina, Ileana L.

AU - O'Connor, Christopher M.

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N2 - Objectives: The purpose of this study was to determine whether exercise training is associated with an increased risk of implantable cardioverter-defibrillator (ICD) therapy in patients with heart failure (HF). Background: Few data are available regarding the safety of exercise training in patients with ICDs and HF. Methods: HF-ACTION (Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing) randomized 2,331 outpatients with HF and an ejection fraction (EF) ≤35% to exercise training or usual care. Cox proportional hazards modeling was used to examine the relationship between exercise training and ICD shocks. Results: We identified 1,053 patients (45%) with an ICD at baseline who were randomized to exercise training (n = 546) or usual care (n = 507). Median age was 61 years old, and median EF was 24%. Over a median of 2.2 years of follow-up, 20% (n = 108) of the exercise patients had a shock versus 22% (n = 113) of the control patients. A history of sustained ventricular tachycardia/fibrillation (hazard ratio [HR]: 1.93 [95% confidence interval (CI): 1.47 to 2.54]), previous atrial fibrillation/flutter (HR: 1.63 [95% CI: 1.22 to 2.18]), exercise-induced dysrhythmia (HR: 1.67 [95% CI: 1.23 to 2.26]), lower diastolic blood pressure (HR for 5-mm Hg decrease <60: 1.35 [95% CI: 1.12 to 1.61]), and nonwhite race (HR: 1.50 [95% CI: 1.13 to 2.00]) were associated with an increased risk of ICD shocks. Exercise training was not associated with the occurrence of ICD shocks (HR: 0.90 [95% CI: 0.69 to 1.18], p = 0.45). The presence of an ICD was not associated with the primary efficacy composite endpoint of death or hospitalization (HR: 0.99 [95% CI: 0.86 to 1.14], p = 0.90). Conclusions: We found no evidence of increased ICD shocks in patients with HF and reduced left ventricular function who underwent exercise training. Exercise therapy should not be prohibited in ICD recipients with HF. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437).

AB - Objectives: The purpose of this study was to determine whether exercise training is associated with an increased risk of implantable cardioverter-defibrillator (ICD) therapy in patients with heart failure (HF). Background: Few data are available regarding the safety of exercise training in patients with ICDs and HF. Methods: HF-ACTION (Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing) randomized 2,331 outpatients with HF and an ejection fraction (EF) ≤35% to exercise training or usual care. Cox proportional hazards modeling was used to examine the relationship between exercise training and ICD shocks. Results: We identified 1,053 patients (45%) with an ICD at baseline who were randomized to exercise training (n = 546) or usual care (n = 507). Median age was 61 years old, and median EF was 24%. Over a median of 2.2 years of follow-up, 20% (n = 108) of the exercise patients had a shock versus 22% (n = 113) of the control patients. A history of sustained ventricular tachycardia/fibrillation (hazard ratio [HR]: 1.93 [95% confidence interval (CI): 1.47 to 2.54]), previous atrial fibrillation/flutter (HR: 1.63 [95% CI: 1.22 to 2.18]), exercise-induced dysrhythmia (HR: 1.67 [95% CI: 1.23 to 2.26]), lower diastolic blood pressure (HR for 5-mm Hg decrease <60: 1.35 [95% CI: 1.12 to 1.61]), and nonwhite race (HR: 1.50 [95% CI: 1.13 to 2.00]) were associated with an increased risk of ICD shocks. Exercise training was not associated with the occurrence of ICD shocks (HR: 0.90 [95% CI: 0.69 to 1.18], p = 0.45). The presence of an ICD was not associated with the primary efficacy composite endpoint of death or hospitalization (HR: 0.99 [95% CI: 0.86 to 1.14], p = 0.90). Conclusions: We found no evidence of increased ICD shocks in patients with HF and reduced left ventricular function who underwent exercise training. Exercise therapy should not be prohibited in ICD recipients with HF. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437).

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