Emily P Zeitler1, Jonathan P Piccini2, Anne S Hellkamp3, David J Whellan4, Kevin P Jackson1, Stephen J Ellis1, William E Kraus1, Steven J Keteyian5, Dalane W Kitzman6, Gregory A Ewald7, Jerome L Fleg8, Ileana L Piña9, Christopher M O'Connor1. 1. Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina. 2. Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina. Electronic address: jonathan.piccini@duke.edu. 3. Duke Clinical Research Institute, Durham, North Carolina. 4. Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania. 5. Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan. 6. Section of Cardiology, Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina. 7. Division of Cardiovascular Diseases, Washington University, St Louis, Missouri. 8. National Heart, Lung, and Blood Institute, Bethesda, Maryland. 9. Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York.
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% tousual 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 VO2 (P < .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.
RCT Entities:
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 VO2 (P < .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.
Authors: Luc Vanhees; Marion Kornaat; Johan Defoor; Geert Aufdemkampe; Dirk Schepers; An Stevens; Henk Van Exel; Jeroen Van Den Beld; Hein Heidbüchel; Robert Fagard Journal: Eur Heart J Date: 2004-07 Impact factor: 29.983
Authors: Sharon Ann Hunt; William T Abraham; Marshall H Chin; Arthur M Feldman; Gary S Francis; Theodore G Ganiats; Mariell Jessup; Marvin A Konstam; Donna M Mancini; Keith Michl; John A Oates; Peter S Rahko; Marc A Silver; Lynne Warner Stevenson; Clyde W Yancy; Elliott M Antman; Sidney C Smith; Cynthia D Adams; Jeffrey L Anderson; David P Faxon; Valentin Fuster; Jonathan L Halperin; Loren F Hiratzka; Alice K Jacobs; Rick Nishimura; Joseph P Ornato; Richard L Page; Barbara Riegel Journal: Circulation Date: 2005-09-13 Impact factor: 29.690
Authors: Christopher M O'Connor; David J Whellan; Kerry L Lee; Steven J Keteyian; Lawton S Cooper; Stephen J Ellis; Eric S Leifer; William E Kraus; Dalane W Kitzman; James A Blumenthal; David S Rendall; Nancy Houston Miller; Jerome L Fleg; Kevin A Schulman; Robert S McKelvie; Faiez Zannad; Ileana L Piña Journal: JAMA Date: 2009-04-08 Impact factor: 56.272
Authors: Kathryn E Flynn; Ileana L Piña; David J Whellan; Li Lin; James A Blumenthal; Stephen J Ellis; Lawrence J Fine; Jonathan G Howlett; Steven J Keteyian; Dalane W Kitzman; William E Kraus; Nancy Houston Miller; Kevin A Schulman; John A Spertus; Christopher M O'Connor; Kevin P Weinfurt Journal: JAMA Date: 2009-04-08 Impact factor: 56.272
Authors: Bruce L Wilkoff; James R Cook; Andrew E Epstein; H Leon Greene; Alfred P Hallstrom; Henry Hsia; Steven P Kutalek; Arjun Sharma Journal: JAMA Date: 2002-12-25 Impact factor: 56.272
Authors: Daniel R Bensimhon; George L Adams; David J Whellan; Robert A Pagnanelli; Mark Trimble; Benjamin A Lee; Kerry L Lee; Stephen J Ellis; William E Kraus; David S Rendall; Ami E Iskandrian; Christopher M O'Connor; Salvador Borges-Neto Journal: Am Heart J Date: 2007-07 Impact factor: 4.749
Authors: Helena Santa-Clara; Ana Abreu; Xavier Melo; Vanessa Santos; Pedro Cunha; Mário Oliveira; Rita Pinto; Miguel Mota Carmo; Bo Fernhall Journal: Eur J Appl Physiol Date: 2019-05-23 Impact factor: 3.078
Authors: Linda Long; Ify R Mordi; Charlene Bridges; Viral A Sagar; Edward J Davies; Andrew Js Coats; Hasnain Dalal; Karen Rees; Sally J Singh; Rod S Taylor Journal: Cochrane Database Syst Rev Date: 2019-01-29
Authors: Thomas T H Wan; Amanda Terry; Enesha Cobb; Bobbie McKee; Rebecca Tregerman; Sara D S Barbaro Journal: Health Serv Res Manag Epidemiol Date: 2017-04-18