June 22, 2017Circulation112 citationsOpen Access
View Full PaperPhysical Activity and Prognosis in the TOPCAT Trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist)
Key Result
Poor baseline physical activity in patients with HFpEF was associated with a greater risk of the primary composite outcome compared with ideal physical activity (HR 2.05; 95% CI 1.28-3.28).
Study Design
Type
Cohort (n=1,751)
Multicenter
Yes
Structured PICO
Does ideal physical activity reduce the risk of adverse cardiovascular outcomes in patients with heart failure with preserved ejection fraction compared to poor or intermediate physical activity?
P
Population
1751 patients with heart failure with preserved ejection fraction (HFpEF) enrolled in the Americas region of the TOPCAT trial, mean age 68.6±9.6 years.
I
Intervention
Ideal baseline self-reported physical activity (American Heart Association criteria)
C
Comparator
Poor or intermediate baseline self-reported physical activity
O
Outcome
Composite of HF hospitalization, cardiovascular mortality, or aborted cardiac arrestcomposite
In patients with HFpEF, poor and intermediate self-reported physical activity are associated with a significantly higher risk of HF hospitalization and mortality compared to ideal physical activity.
Main Result
Effect estimate: HR 2.05 (95% CI 1.28-3.28)
Abstract
BACKGROUND: Physical activity (PA) is inversely associated with adverse cardiovascular outcomes in healthy populations, but the impact of physical activity in patients with heart failure (HF) with preserved ejection fraction is less well characterized. METHODS: The baseline self-reported PA of 1751 subjects enrolled in the Americas region of the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) was categorized as poor, intermediate, or ideal PA with American Heart Association criteria. PA was related to the primary composite outcome (HF hospitalization, cardiovascular mortality, or aborted cardiac arrest), its components, and all-cause mortality with the use of multivariable Cox models. RESULTS: The mean age at enrollment was 68.6±9.6 years. Few patients met American Heart Association criteria for ideal activity (11% ideal, 14% intermediate, 75% poor). Over a median follow-up of 2.4 years, the primary composite outcome occurred in 519 patients (397 HF hospitalizations, 222 cardiovascular deaths, and 6 aborted cardiac arrests). Compared with those with ideal baseline PA, poor and intermediate baseline PA was associated with a greater risk of the primary outcome (hazard ratio HR, 2.05; 95% confidence interval CI, 1.28-3.28; HR, 1.95; 95% CI, 1.15-3.33, respectively), HF hospitalization (HR, 1.93; 95% CI, 1.16-3.22; HR, 1.84; 95% CI, 1.02-3.31), cardiovascular mortality (HR, 4.36; 95% CI, 1.37-13.83; HR, 4.05; 95% CI, 1.17-14.04), and all-cause mortality (HR, 2.95; 95% CI, 1.44-6.02; HR, 2.05; 95% CI, 0.90-4.67) after multivariable adjustment for potential confounders. CONCLUSIONS: In patients with HF with preserved ejection fraction, both poor and intermediate self-reported PA were associated with higher risk of HF hospitalization and mortality. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT00094302.