Andrew P Ambrosy1, Lukasz P Cerbin2, Adam D DeVore1, Stephen J Greene1, William E Kraus1, Christopher M O'Connor3, Ileana L Piña4, David J Whellan5, Daniel Wojdyla6, Angie Wu6, Robert J Mentz7. 1. Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA. 2. Duke University Medical Center, Durham, NC, USA. 3. Duke Clinical Research Institute, Durham, NC, USA; Inova Heart and Vascular Institute, Falls Church, VA, USA. 4. Albert Einstein College of Medicine, Bronx, NY, USA. 5. Jefferson Medical College, Philadelphia, PA. USA. 6. Duke Clinical Research Institute, Durham, NC, USA. 7. Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA. Electronic address: robert.mentz@dm.duke.edu.
Abstract
BACKGROUND: Although aerobic exercise improves quality of life as assessed by a disease-specific instrument in ambulatory HF patients with a reduced ejection fraction (EF), the impact of an exercise intervention on general health status has not been previously reported. METHODS: A secondary analysis was performed of the HF-ACTION trial (ClinicalTrials.gov Number: NCT00047437), which enrolled 2331 medically stable outpatients with HF and an EF ≤35% and randomized them toaerobic exercise training, consisting of 36 supervised sessions followed by home-based training versus usual care for a median follow-up of 30 months. The EuroQOL 5-dimension questionnaire (EQ-5D) was administered to study participants at baseline, 3 months, and 12 months. EQ-5D includes functional dimensions (ie, mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), which were mapped to corresponding utility scores (ie, 0=death and 1=perfect health), and a visual analogue scale (VAS) ranging from 0 (ie, "worst imaginable health state") to 100 (ie, "best imaginable health state"). RESULTS:Study participants had a median (25th, 75th) age of 59 (51, 68) years and 71% were male. A history of ischemic heart disease was reported in 51% of participants and the EF was 25% (20%, 30%). Baseline VAS and mapped utility scores were 65±19 and 0.81±0.14. Exercise training led to an improvement in VAS score compared with usual care from baseline to 3 months (exercise training: 6±17 vs usual care: 3±20; P <.01) although there were no further significant changes at 12 months. Aerobic exercise training did not favorably change mapped utility scores over either timeframe. After multivariable adjustment, lower mapped utility (hazard ratio [HR] 1.19 per 0.1 decrease, 95% CI 1.09-1.29; P < .0001) and VAS scores (HR 1.05 per 10 point decrease, 95% CI 1.02-1.08; P < .01) at baseline were associated with increased risk of death or hospitalization. CONCLUSION: Ambulatory HF patients with a reduced EF had impaired health status at baseline which was associated with increased morbidity and mortality, in part mitigated by a structured aerobic exercise regimen.
RCT Entities:
BACKGROUND: Although aerobic exercise improves quality of life as assessed by a disease-specific instrument in ambulatory HF patients with a reduced ejection fraction (EF), the impact of an exercise intervention on general health status has not been previously reported. METHODS: A secondary analysis was performed of the HF-ACTION trial (ClinicalTrials.gov Number: NCT00047437), which enrolled 2331 medically stable outpatients with HF and an EF ≤35% and randomized them to aerobic exercise training, consisting of 36 supervised sessions followed by home-based training versus usual care for a median follow-up of 30 months. The EuroQOL 5-dimension questionnaire (EQ-5D) was administered to study participants at baseline, 3 months, and 12 months. EQ-5D includes functional dimensions (ie, mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), which were mapped to corresponding utility scores (ie, 0=death and 1=perfect health), and a visual analogue scale (VAS) ranging from 0 (ie, "worst imaginable health state") to 100 (ie, "best imaginable health state"). RESULTS: Study participants had a median (25th, 75th) age of 59 (51, 68) years and 71% were male. A history of ischemicheart disease was reported in 51% of participants and the EF was 25% (20%, 30%). Baseline VAS and mapped utility scores were 65±19 and 0.81±0.14. Exercise training led to an improvement in VAS score compared with usual care from baseline to 3 months (exercise training: 6±17 vs usual care: 3±20; P <.01) although there were no further significant changes at 12 months. Aerobic exercise training did not favorably change mapped utility scores over either timeframe. After multivariable adjustment, lower mapped utility (hazard ratio [HR] 1.19 per 0.1 decrease, 95% CI 1.09-1.29; P < .0001) and VAS scores (HR 1.05 per 10 point decrease, 95% CI 1.02-1.08; P < .01) at baseline were associated with increased risk of death or hospitalization. CONCLUSION: Ambulatory HF patients with a reduced EF had impaired health status at baseline which was associated with increased morbidity and mortality, in part mitigated by a structured aerobic exercise regimen.
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: A J Gingele; B Ramaekers; H P Brunner-La Rocca; G De Weerd; J Kragten; V van Empel; K van der Weg; H J M Vrijhoef; A Gorgels; G Cleuren; J J J Boyne; C Knackstedt Journal: Neth Heart J Date: 2019-11 Impact factor: 2.380
Authors: Hasnain M Dalal; Rod S Taylor; Kate Jolly; Russell C Davis; Patrick Doherty; Jackie Miles; Robin van Lingen; Fiona C Warren; Colin Green; Jennifer Wingham; Colin Greaves; Susannah Sadler; Melvyn Hillsdon; Charles Abraham; Nicky Britten; Julia Frost; Sally Singh; Christopher Hayward; Victoria Eyre; Kevin Paul; Chim C Lang; Karen Smith Journal: Eur J Prev Cardiol Date: 2018-10-10 Impact factor: 7.804