Key result
Exercise training reduces death and hospitalization ~12% in chronic HF, varying by beta-blocker use.
Why the study?
The study aimed to identify significant factors affecting the effectiveness of exercise training using data from the HF-ACTION trial.
Does exercise training reduce all-cause death and hospitalization in specific subpopulations of patients with chronic heart failure with reduced ejection fraction?
Does exercise training reduce all-cause death and hospitalization in specific subpopulations of patients with chronic heart failure with reduced ejection fraction?
Effect estimate: HR 0.88 (95% CI 0.82-0.94)
The effectiveness of exercise training in HFrEF patients is heterogeneous and depends on baseline characteristics, suggesting a personalized approach may be needed to maximize benefit and minimize harm.
Exercise effects on death/hospitalization appear heterogeneous in HFrEF; leaves open whether baseline factors enable safe, effective personalization.
Background: The aim of this study was to identify significant factors affecting the effectiveness of exercise training using information of the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) study. Methods: Background factors influencing the effect of exercise training were comprehensively surveyed for 2,130 patients by multivariable Cox regression analysis with the stepwise variable selection, and only significant factors were selected that were statistically distinguished from dummy noise factors using the Boruta method. Results: The analysis suggested that the use of beta-blockers, pulse pressure, hemoglobin level, electrocardiography findings, body mass index, and history of stroke at baseline potentially influenced the exercise effect on all-cause death (AD). Therefore, a hypothetical score to estimate the effect of exercise training was constructed based on the analysis. The analysis suggested that the score is useful in identifying patients for whom exercise training may be significantly effective in reducing all-caused death and hospitalization (ADH) as well as AD. Such a subpopulation accounted for approximately 40% of the overall study population. On the other hand, in approximately 45% of patients, the effect of exercise was unclear on either AD or ADH. In the remaining 15% of patients, it was estimated that the effect of exercise might be unclear for ADH and potentially rather increase AD. Conclusions: analyses of a single clinical trial, the characteristics of patients to whom the results of this analysis can be applied need attention, and also further research is necessary on the relationship between the degree of exercise and the outcomes. A new clinical trial would be needed to confirm the factors detected and the appropriateness of the score.
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Soejima et al. (2024) studied Chronic heart failure with reduced ejection fraction (n=2,130). Exercise training vs. Usual care was evaluated on All-cause death and hospitalization (ADH) (HR 0.88, 95% CI 0.82-0.94). Exercise training reduced the risk of all-cause death and hospitalization (HR 0.88) in patients with chronic heart failure, though its effectiveness varied significantly based on baseline characteristics such as beta-blocker use.
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