Exercise Training in Patients With Chronic Heart Failure and Atrial Fibrillation

Nancy Luo, Peter Merrill, Kishan S. Parikh, David J. Whellan, Ileana L. Pina, Mona Fiuzat, William E. Kraus, Dalane W. Kitzman, Steven J. Keteyian, Christopher M. O'Connor, Robert J. Mentz

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background The safety and efficacy of aerobic exercise in heart failure (HF) patients with atrial fibrillation (AF) has not been well evaluated. Objectives This study examined whether outcomes with exercise training in HF vary according to AF status. Methods HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) randomized 2,331 ambulatory HF patients with ejection fraction ≤35% to exercise training or usual care. We examined clinical characteristics and outcomes (mortality/hospitalization) by baseline AF status (past history of AF or AF on baseline electrocardiogram vs. no AF) using adjusted Cox models and explored an interaction with exercise training. We assessed post-randomization AF events diagnosed via hospitalizations for AF and reports of serious arrhythmia caused by AF. Results Of 2,292 patients with baseline rhythm data, 382 (17%) had AF, 1,602 (70%) had sinus rhythm, and 308 (13%) had “other” rhythm. Patients with AF were older and had lower peak VO2. Over a median follow-up of 2.6 years, AF was associated with a 24% per year higher rate of mortality/hospitalization (hazard ratio [HR]: 1.53; 95% confidence interval [CI]: 1.34 to 1.74; p < 0.001) in unadjusted analysis; this did not remain significant after adjustment (HR: 1.15; 95% CI: 0.98 to 1.35; p = 0.09). There was no significant difference in AF event rates by randomized treatment assignment in the overall population or by baseline AF status (all p > 0.10). There was no interaction between AF and exercise training on measures of functional status or clinical outcomes (all p > 0.10). Conclusions AF in patients with chronic HF was associated with older age, reduced exercise capacity at baseline, and a higher overall rate of clinical events, but not a differential response to exercise training for clinical outcomes or changes in exercise capacity. (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF-ACTION]; NCT00047437)

Original languageEnglish (US)
Pages (from-to)1683-1691
Number of pages9
JournalJournal of the American College of Cardiology
Volume69
Issue number13
DOIs
StatePublished - Apr 4 2017

Fingerprint

Atrial Fibrillation
Heart Failure
Exercise
Hospitalization
Mortality
Random Allocation
Proportional Hazards Models
Cardiac Arrhythmias
Electrocardiography
Confidence Intervals
Safety

Keywords

  • arrhythmia
  • cardiopulmonary reserve
  • exercise training
  • fitness

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Luo, N., Merrill, P., Parikh, K. S., Whellan, D. J., Pina, I. L., Fiuzat, M., ... Mentz, R. J. (2017). Exercise Training in Patients With Chronic Heart Failure and Atrial Fibrillation. Journal of the American College of Cardiology, 69(13), 1683-1691. https://doi.org/10.1016/j.jacc.2017.01.032

Exercise Training in Patients With Chronic Heart Failure and Atrial Fibrillation. / Luo, Nancy; Merrill, Peter; Parikh, Kishan S.; Whellan, David J.; Pina, Ileana L.; Fiuzat, Mona; Kraus, William E.; Kitzman, Dalane W.; Keteyian, Steven J.; O'Connor, Christopher M.; Mentz, Robert J.

In: Journal of the American College of Cardiology, Vol. 69, No. 13, 04.04.2017, p. 1683-1691.

Research output: Contribution to journalArticle

Luo, N, Merrill, P, Parikh, KS, Whellan, DJ, Pina, IL, Fiuzat, M, Kraus, WE, Kitzman, DW, Keteyian, SJ, O'Connor, CM & Mentz, RJ 2017, 'Exercise Training in Patients With Chronic Heart Failure and Atrial Fibrillation', Journal of the American College of Cardiology, vol. 69, no. 13, pp. 1683-1691. https://doi.org/10.1016/j.jacc.2017.01.032
Luo, Nancy ; Merrill, Peter ; Parikh, Kishan S. ; Whellan, David J. ; Pina, Ileana L. ; Fiuzat, Mona ; Kraus, William E. ; Kitzman, Dalane W. ; Keteyian, Steven J. ; O'Connor, Christopher M. ; Mentz, Robert J. / Exercise Training in Patients With Chronic Heart Failure and Atrial Fibrillation. In: Journal of the American College of Cardiology. 2017 ; Vol. 69, No. 13. pp. 1683-1691.
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abstract = "Background The safety and efficacy of aerobic exercise in heart failure (HF) patients with atrial fibrillation (AF) has not been well evaluated. Objectives This study examined whether outcomes with exercise training in HF vary according to AF status. Methods HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) randomized 2,331 ambulatory HF patients with ejection fraction ≤35{\%} to exercise training or usual care. We examined clinical characteristics and outcomes (mortality/hospitalization) by baseline AF status (past history of AF or AF on baseline electrocardiogram vs. no AF) using adjusted Cox models and explored an interaction with exercise training. We assessed post-randomization AF events diagnosed via hospitalizations for AF and reports of serious arrhythmia caused by AF. Results Of 2,292 patients with baseline rhythm data, 382 (17{\%}) had AF, 1,602 (70{\%}) had sinus rhythm, and 308 (13{\%}) had “other” rhythm. Patients with AF were older and had lower peak VO2. Over a median follow-up of 2.6 years, AF was associated with a 24{\%} per year higher rate of mortality/hospitalization (hazard ratio [HR]: 1.53; 95{\%} confidence interval [CI]: 1.34 to 1.74; p < 0.001) in unadjusted analysis; this did not remain significant after adjustment (HR: 1.15; 95{\%} CI: 0.98 to 1.35; p = 0.09). There was no significant difference in AF event rates by randomized treatment assignment in the overall population or by baseline AF status (all p > 0.10). There was no interaction between AF and exercise training on measures of functional status or clinical outcomes (all p > 0.10). Conclusions AF in patients with chronic HF was associated with older age, reduced exercise capacity at baseline, and a higher overall rate of clinical events, but not a differential response to exercise training for clinical outcomes or changes in exercise capacity. (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF-ACTION]; NCT00047437)",
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AU - Luo, Nancy

AU - Merrill, Peter

AU - Parikh, Kishan S.

AU - Whellan, David J.

AU - Pina, Ileana L.

AU - Fiuzat, Mona

AU - Kraus, William E.

AU - Kitzman, Dalane W.

AU - Keteyian, Steven J.

AU - O'Connor, Christopher M.

AU - Mentz, Robert J.

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N2 - Background The safety and efficacy of aerobic exercise in heart failure (HF) patients with atrial fibrillation (AF) has not been well evaluated. Objectives This study examined whether outcomes with exercise training in HF vary according to AF status. Methods HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) randomized 2,331 ambulatory HF patients with ejection fraction ≤35% to exercise training or usual care. We examined clinical characteristics and outcomes (mortality/hospitalization) by baseline AF status (past history of AF or AF on baseline electrocardiogram vs. no AF) using adjusted Cox models and explored an interaction with exercise training. We assessed post-randomization AF events diagnosed via hospitalizations for AF and reports of serious arrhythmia caused by AF. Results Of 2,292 patients with baseline rhythm data, 382 (17%) had AF, 1,602 (70%) had sinus rhythm, and 308 (13%) had “other” rhythm. Patients with AF were older and had lower peak VO2. Over a median follow-up of 2.6 years, AF was associated with a 24% per year higher rate of mortality/hospitalization (hazard ratio [HR]: 1.53; 95% confidence interval [CI]: 1.34 to 1.74; p < 0.001) in unadjusted analysis; this did not remain significant after adjustment (HR: 1.15; 95% CI: 0.98 to 1.35; p = 0.09). There was no significant difference in AF event rates by randomized treatment assignment in the overall population or by baseline AF status (all p > 0.10). There was no interaction between AF and exercise training on measures of functional status or clinical outcomes (all p > 0.10). Conclusions AF in patients with chronic HF was associated with older age, reduced exercise capacity at baseline, and a higher overall rate of clinical events, but not a differential response to exercise training for clinical outcomes or changes in exercise capacity. (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF-ACTION]; NCT00047437)

AB - Background The safety and efficacy of aerobic exercise in heart failure (HF) patients with atrial fibrillation (AF) has not been well evaluated. Objectives This study examined whether outcomes with exercise training in HF vary according to AF status. Methods HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) randomized 2,331 ambulatory HF patients with ejection fraction ≤35% to exercise training or usual care. We examined clinical characteristics and outcomes (mortality/hospitalization) by baseline AF status (past history of AF or AF on baseline electrocardiogram vs. no AF) using adjusted Cox models and explored an interaction with exercise training. We assessed post-randomization AF events diagnosed via hospitalizations for AF and reports of serious arrhythmia caused by AF. Results Of 2,292 patients with baseline rhythm data, 382 (17%) had AF, 1,602 (70%) had sinus rhythm, and 308 (13%) had “other” rhythm. Patients with AF were older and had lower peak VO2. Over a median follow-up of 2.6 years, AF was associated with a 24% per year higher rate of mortality/hospitalization (hazard ratio [HR]: 1.53; 95% confidence interval [CI]: 1.34 to 1.74; p < 0.001) in unadjusted analysis; this did not remain significant after adjustment (HR: 1.15; 95% CI: 0.98 to 1.35; p = 0.09). There was no significant difference in AF event rates by randomized treatment assignment in the overall population or by baseline AF status (all p > 0.10). There was no interaction between AF and exercise training on measures of functional status or clinical outcomes (all p > 0.10). Conclusions AF in patients with chronic HF was associated with older age, reduced exercise capacity at baseline, and a higher overall rate of clinical events, but not a differential response to exercise training for clinical outcomes or changes in exercise capacity. (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF-ACTION]; NCT00047437)

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