期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 69, 期 13, 页码 1683-1691出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2017.01.032
关键词
arrhythmia; cardiopulmonary reserve; exercise training; fitness
资金
- National Heart, Lung, and Blood Institute
- National Institutes of Health [U10HL110312, R01AG045551-01A1]
- Amgen
- AstraZeneca
- Bayer
- Bristol-Myers Squibb
- GlaxoSmithKline
- Gilead
- Luitpold
- Medtronic
- Merck
- Novartis
- Otsuka
- ResMed
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]; (C) 2017 by the American College of Cardiology Foundation.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据