Exercise Training in Patients With Chronic Heart Failure and Atrial Fibrillation

Post on April 17, 2017 by André Broussard, D.C.

April 14, 2017
JACC: Journal of the American College of Cardiology

TAKE-HOME MESSAGE

  • This randomized trial examined the effects of aerobic exercise in 2331 ambulatory patients with heart failure (ejection fraction ≤35%) with and without atrial fibrillation. Of the total population, 17% (n = 382) had atrial fibrillation at enrollment. After a median follow-up of 2.6 years, regardless of diagnosis of atrial fibrillation at enrollment, no difference was found in atrial fibrillation event rates between groups assigned to exercise and usual care. Compared with patients without atrial fibrillation, patients with atrial fibrillation had poorer exercise capacity at baseline and higher rates of clinical events during the trial. Patients with and without atrial fibrillation experienced modest benefits from exercise training.
  • These study results highlight that exercise therapy is safe and modestly beneficial in heart failure patients with and without atrial fibrillation.

 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.

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