Exercise Training in Patients With Chronic Heart Failure and Atrial Fibrillation.
J Am Coll Cardiol
; 69(13): 1683-1691, 2017 Apr 04.
Article
em En
| MEDLINE
| ID: mdl-28359513
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).Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Fibrilação Atrial
/
Exercício Físico
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Tolerância ao Exercício
/
Insuficiência Cardíaca
Tipo de estudo:
Clinical_trials
/
Prognostic_studies
Limite:
Aged
/
Female
/
Humans
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Male
/
Middle aged
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article