Exercise training and pacing status in patients with heart failure: Results from HF-ACTION

Emily P. Zeitler; Jonathan P. Piccini; Anne S. Hellkamp; David J. Whellan; Kevin P. Jackson; Stephen J. Ellis; William E. Kraus; Steven J. Keteyian; Dalane W. Kitzman; Gregory A. Ewald; Jerome L. Fleg; Ileana L. Piña; Christopher M. O'Connor

doi:10.1016/j.cardfail.2014.10.004

Exercise training and pacing status in patients with heart failure: Results from HF-ACTION

Emily P. Zeitler, Jonathan P. Piccini, Anne S. Hellkamp, David J. Whellan, Kevin P. Jackson, Stephen J. Ellis, William E. Kraus, Steven J. Keteyian, Dalane W. Kitzman, Gregory A. Ewald, Jerome L. Fleg, Ileana L. Piña, Christopher M. O'Connor

Medicine

Research output: Contribution to journal › Article › peer-review

23 Scopus citations

Abstract

Background We sought to determine if outcomes with exercise training in heart failure (HF) vary according to ventricular pacing type.

Methods and Results Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) randomized 2,331 outpatients with HF and left ventricular ejection fraction ≤35% to usual care plus exercise training or usual care alone. We examined the relationship between outcomes and randomized treatment according to ventricular pacing status with the use of Cox proportional hazards modeling. In HF-ACTION 1,118 patients (48%) had an implanted cardiac rhythm device: 683 with right ventricular (RV) and 435 with biventricular (BiV) pacemakers. Patients with pacing devices were older, more frequently white, and had lower peak VO;bsubesub (P ;lt.001 for all). Peak VO₂ improved similarly with training in groups with and without pacing devices. The primary composite end point - all-cause death or hospitalization - was reduced only in patients randomized to exercise training without a device (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.67-0.93 [P =.004]; RV lead: HR 1.04, 95% CI 0.84-1.28 [P =.74]; BiV pacing: HR 1.05, 95% CI 0.82-1.34 [P =.72]; interaction P =.058).

Conclusions Exercise training may improve exercise capacity in patients with implanted cardiac devices. However, the apparent beneficial effects of exercise on hospitalization or death may be attenuated in patients with implanted cardiac devices and requires further study.

Original language	English (US)
Pages (from-to)	60-67
Number of pages	8
Journal	Journal of Cardiac Failure
Volume	21
Issue number	1
DOIs	https://doi.org/10.1016/j.cardfail.2014.10.004
State	Published - Jan 1 2015

Keywords

Heart failure
exercise
implanted cardiac pacemaker
mortality

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

Access to Document

10.1016/j.cardfail.2014.10.004

Cite this

Zeitler, E. P., Piccini, J. P., Hellkamp, A. S., Whellan, D. J., Jackson, K. P., Ellis, S. J., Kraus, W. E., Keteyian, S. J., Kitzman, D. W., Ewald, G. A., Fleg, J. L., Piña, I. L., & O'Connor, C. M. (2015). Exercise training and pacing status in patients with heart failure: Results from HF-ACTION. Journal of Cardiac Failure, 21(1), 60-67. https://doi.org/10.1016/j.cardfail.2014.10.004

@article{5c78996219f540f3bd1b31d8178db84f,

title = "Exercise training and pacing status in patients with heart failure: Results from HF-ACTION",

abstract = "Background We sought to determine if outcomes with exercise training in heart failure (HF) vary according to ventricular pacing type.Methods and Results Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) randomized 2,331 outpatients with HF and left ventricular ejection fraction ≤35% to usual care plus exercise training or usual care alone. We examined the relationship between outcomes and randomized treatment according to ventricular pacing status with the use of Cox proportional hazards modeling. In HF-ACTION 1,118 patients (48%) had an implanted cardiac rhythm device: 683 with right ventricular (RV) and 435 with biventricular (BiV) pacemakers. Patients with pacing devices were older, more frequently white, and had lower peak VO;bsubesub (P ;lt.001 for all). Peak VO2 improved similarly with training in groups with and without pacing devices. The primary composite end point - all-cause death or hospitalization - was reduced only in patients randomized to exercise training without a device (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.67-0.93 [P =.004]; RV lead: HR 1.04, 95% CI 0.84-1.28 [P =.74]; BiV pacing: HR 1.05, 95% CI 0.82-1.34 [P =.72]; interaction P =.058).Conclusions Exercise training may improve exercise capacity in patients with implanted cardiac devices. However, the apparent beneficial effects of exercise on hospitalization or death may be attenuated in patients with implanted cardiac devices and requires further study.",

keywords = "Heart failure, exercise, implanted cardiac pacemaker, mortality",

author = "Zeitler, {Emily P.} and Piccini, {Jonathan P.} and Hellkamp, {Anne S.} and Whellan, {David J.} and Jackson, {Kevin P.} and Ellis, {Stephen J.} and Kraus, {William E.} and Keteyian, {Steven J.} and Kitzman, {Dalane W.} and Ewald, {Gregory A.} and Fleg, {Jerome L.} and Pi{\~n}a, {Ileana L.} and O'Connor, {Christopher M.}",

note = "Publisher Copyright: {\textcopyright} 2015 Published by Elsevier Inc.",

year = "2015",

month = jan,

day = "1",

doi = "10.1016/j.cardfail.2014.10.004",

language = "English (US)",

volume = "21",

pages = "60--67",

journal = "Journal of Cardiac Failure",

issn = "1071-9164",

publisher = "Churchill Livingstone",

number = "1",

}

TY - JOUR

T1 - Exercise training and pacing status in patients with heart failure

T2 - Results from HF-ACTION

AU - Zeitler, Emily P.

AU - Piccini, Jonathan P.

AU - Hellkamp, Anne S.

AU - Whellan, David J.

AU - Jackson, Kevin P.

AU - Ellis, Stephen J.

AU - Kraus, William E.

AU - Keteyian, Steven J.

AU - Kitzman, Dalane W.

AU - Ewald, Gregory A.

AU - Fleg, Jerome L.

AU - Piña, Ileana L.

AU - O'Connor, Christopher M.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background We sought to determine if outcomes with exercise training in heart failure (HF) vary according to ventricular pacing type.Methods and Results Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) randomized 2,331 outpatients with HF and left ventricular ejection fraction ≤35% to usual care plus exercise training or usual care alone. We examined the relationship between outcomes and randomized treatment according to ventricular pacing status with the use of Cox proportional hazards modeling. In HF-ACTION 1,118 patients (48%) had an implanted cardiac rhythm device: 683 with right ventricular (RV) and 435 with biventricular (BiV) pacemakers. Patients with pacing devices were older, more frequently white, and had lower peak VO;bsubesub (P ;lt.001 for all). Peak VO2 improved similarly with training in groups with and without pacing devices. The primary composite end point - all-cause death or hospitalization - was reduced only in patients randomized to exercise training without a device (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.67-0.93 [P =.004]; RV lead: HR 1.04, 95% CI 0.84-1.28 [P =.74]; BiV pacing: HR 1.05, 95% CI 0.82-1.34 [P =.72]; interaction P =.058).Conclusions Exercise training may improve exercise capacity in patients with implanted cardiac devices. However, the apparent beneficial effects of exercise on hospitalization or death may be attenuated in patients with implanted cardiac devices and requires further study.

AB - Background We sought to determine if outcomes with exercise training in heart failure (HF) vary according to ventricular pacing type.Methods and Results Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) randomized 2,331 outpatients with HF and left ventricular ejection fraction ≤35% to usual care plus exercise training or usual care alone. We examined the relationship between outcomes and randomized treatment according to ventricular pacing status with the use of Cox proportional hazards modeling. In HF-ACTION 1,118 patients (48%) had an implanted cardiac rhythm device: 683 with right ventricular (RV) and 435 with biventricular (BiV) pacemakers. Patients with pacing devices were older, more frequently white, and had lower peak VO;bsubesub (P ;lt.001 for all). Peak VO2 improved similarly with training in groups with and without pacing devices. The primary composite end point - all-cause death or hospitalization - was reduced only in patients randomized to exercise training without a device (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.67-0.93 [P =.004]; RV lead: HR 1.04, 95% CI 0.84-1.28 [P =.74]; BiV pacing: HR 1.05, 95% CI 0.82-1.34 [P =.72]; interaction P =.058).Conclusions Exercise training may improve exercise capacity in patients with implanted cardiac devices. However, the apparent beneficial effects of exercise on hospitalization or death may be attenuated in patients with implanted cardiac devices and requires further study.

KW - Heart failure

KW - exercise

KW - implanted cardiac pacemaker

KW - mortality

UR - http://www.scopus.com/inward/record.url?scp=84919663948&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84919663948&partnerID=8YFLogxK

U2 - 10.1016/j.cardfail.2014.10.004

DO - 10.1016/j.cardfail.2014.10.004

M3 - Article

C2 - 25463413

AN - SCOPUS:84919663948

SN - 1071-9164

VL - 21

SP - 60

EP - 67

JO - Journal of Cardiac Failure

JF - Journal of Cardiac Failure

IS - 1

ER -

Exercise training and pacing status in patients with heart failure: Results from HF-ACTION

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this