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HF-ACTION: Exercise program yielded modest benefit for patients with HF
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Patients with heart failure who undergo exercise training may gain a modest benefit, according to results of the HF-ACTION study.
HF-ACTION researchers enrolled 2,331 patients with NYHA II – IV chronic HF who were capable of exercising into the study. Patients were then randomized at a 1:1 ratio to either a usual care group (n=1,172) or supervised exercise training group (n=1,159). The primary outcome was time to all-cause mortality and hospitalization; the secondary endpoints included CV mortality and CV hospitalization. Median follow-up was 2.5 years.
The researchers reported a reduction in time to all-cause mortality in both groups. They also observed a difference between reductions observed in the unadjusted main analysis (7% reduction; HR=0.93; 95% CI, 0.84-1.02) and after adjustment for prognostic variables (11% reduction; HR=0.89; 95% CI, 0.81-0.99). There was a modest 8% to 9% reduction in the secondary endpoint of CV mortality and CV hospitalization after adjusting for prognostic covariates (HR=0.91; 95% CI, 0.82-1.01), as well as a 13% reduction in the secondary endpoint of CV mortality and HF hospitalization (HR=0.87; 95% CI, 0.75-1.00); this became a 15% reduction after adjusting for prognostic covariates (HR=0.85; 95% CI, 0.74-0.99). The three-year mortality rate, according to the researchers, was approximately 3% in both study arms.
“Regular exercise training was shown to be safe in patients with HF and was associated with a modest improvement in physiologic endpoints,” David J. Whelan, MD, a cardiologist at Jefferson Medical College in Philadelphia, said in his presentation. “Based on the safety of exercise training and on a modest reduction in clinical events, the HF-ACTION results support a prescribed exercise training program for patients with reduced left ventricular function and HF symptoms in addition to evidence-based therapy.”
The study results were presented at the 2008 American Heart Association Scientific Sessions in New Orleans.
For more information:
- O’Connor C. Morbidity and mortality outcomes from aerobic exercise training in heart failure: Results of the Heart Failure and A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) Study. LBCT III, # 3318. Presented at: 2008 American Heart Association Scientific Sessions; Nov. 9-12, 2008. New Orleans.
This is an unusually important study. The reason that it is important is because it addresses an issue – exercise – which is a key plan in almost every organization across the world’s endeavor to improve heart disease and to improve general health. This is not a pill against placebo. This is a lifestyle intervention. What this trial does not do is tell us what form of exercise is best for these patients, and perhaps much more important, how is that we can persuade patients to exercise and continue exercising over time. For future research, I suspect we are going to need the help of social scientists and behavioral scientists in order to understand how people can be persuaded to exercise. We will also need urban planning and structural changes within society so that people have available to them the opportunity to exercise.
– Philip A. Poole-Wilson, MD
Professor Emeritus of Cardiology, Imperial College of London