What is the clinical evidence from this study?

Study design: Cohort. Population: Advanced Heart Failure with High B-Type Natriuretic Peptide Level (n=340). Intervention: Exercise training (ET) program vs. Poor improvement in peak VO2 (<1.0%). Primary outcome: Composite of all-cause death or HF hospitalization (p=0.036).

What does this research mean for the field?

In advanced heart failure patients with high BNP levels, a marked improvement in exercise capacity following a 3-month exercise training program reduces the composite rate of all-cause death or HF hospitalization to 37.9% compared to 54.4% in those with poor improvement. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2017Circulation JournalOpen Access

Improvement in Exercise Capacity by Exercise Training Associated With Favorable Clinical Outcomes in Advanced Heart Failure With High B-Type Natriuretic Peptide Level

Q: What are the key findings of this study?

In advanced heart failure patients with high BNP levels, a marked improvement in exercise capacity following a 3-month exercise training program reduced the composite rate of all-cause death or HF hospitalization to 37.9% compared to 54.4% in those with poor improvement.

Q: What does this research mean for the field?

In advanced heart failure patients with high BNP levels, a marked improvement in exercise capacity following a 3-month exercise training program reduces the composite rate of all-cause death or HF hospitalization to 37.9% compared to 54.4% in those with poor improvement. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

In advanced heart failure patients with high BNP levels, a marked improvement in exercise capacity following a 3-month exercise training program reduced the composite rate of all-cause death or HF hospitalization to 37.9% compared to 54.4% in those with poor improvement.

Why the study?

Does improvement in exercise capacity following a 3-month exercise training program improve the composite of all-cause death or heart failure hospitalization in advanced heart failure patients with high BNP levels?

Study Design

Type

Cohort (n=340)

Multicenter

Structured PICO

Population

340 consecutive heart failure patients with LVEF <45% who completed a 3-month exercise training program, mean age 62.1 years, 77.9% male, based in Japan. Key inclusion criteria: LVEF ≤40%, percent-predicted peak VO2 ≤80%, or BNP level ≥80 pg/mL. Key exclusion criteria: LVEF ≥45%, serum creatinine >2.5 mg/dL, history of myocardial infarction within the previous 3 months, or significant pulmonary, cerebrovascular, or orthopedic disease.

Intervention

3-month exercise training (ET) program consisting of supervised in-hospital sessions (walking, bicycle ergometer, and low-intensity resistance training) for 20-40 min per session 3-5 times per week, followed by home ET combined with once or twice per week supervised in-hospital ET sessions. Exercise duration increased to 30-60 min at 40-60% of heart rate reserve or anaerobic threshold.

Outcome

Composite of all-cause death or heart failure hospitalization, analyzed by time from the date of 3-month CPX to first event at a median follow-up of 46 months.composite

Main Result

Absolute Event Rate: 37.9% vs 54.4%

p-value: p=0.036

In advanced heart failure patients with high BNP levels, a greater improvement in exercise capacity following a 3-month exercise training program is independently associated with more favorable long-term clinical outcomes.

Limitations

Retrospective study involving a small number of patients without a control (non-exercise) group at a single institute.
Studied only the patients who had completed the 3-month ET program, which might have resulted in some bias towards a better outcome.
Echocardiographic indices of LV diastolic function at baseline or change in LV function during the ET program were not available.
Findings cannot be generalized to HF patients with preserved LVEF.
Retrospective study
Small number of patients
Without a control (non-exercise) group
Single institute
Selection bias (only studied patients who completed the 3-month ET program)
Lack of echocardiographic indices of LV diastolic function at baseline or change in LV function during the ET program
Only studied HF patients with reduced LVEF (<45%)

Implication

Greater post-training exercise gains were associated with fewer events in advanced HF; hypothesis-generating and needs RCT confirmation.

Abstract

BACKGROUND: The efficacy of exercise training (ET) programs and its relationship with long-term clinical outcomes in advanced heart failure (HF) patients with high levels of B-type natriuretic peptide (BNP) remain uncertain. METHODS AND RESULTS: was a significant independent predictor of the composite outcome and all-cause death. CONCLUSIONS: slope and more favorable long-term clinical outcomes.

Discussion

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Cite This Study

Nakanishi et al. (2017) conducted a cohort in Advanced Heart Failure with High B-Type Natriuretic Peptide Level (n=340). Exercise training (ET) program vs. Poor improvement in peak VO2 (<1.0%) was evaluated on Composite of all-cause death or HF hospitalization (p=0.036). In advanced heart failure patients with high BNP levels, a marked improvement in exercise capacity following a 3-month exercise training program reduced the composite rate of all-cause death or HF hospitalization to 37.9% compared to 54.4% in those with poor improvement.

synapsesocial.com/papers/6a1ada12382248a45185e805 https://doi.org/10.1253/circj.cj-16-1268

Topics

Heart failure

HFrEF treatment

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Implication

Greater post-training exercise gains were associated with fewer events in advanced HF; hypothesis-generating and needs RCT confirmation.

Improvement in Exercise Capacity by Exercise Training Associated With Favorable Clinical Outcomes in Advanced Heart Failure With High B-Type Natriuretic Peptide Level

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Improvement in Exercise Capacity by Exercise Training Associated With Favorable Clinical Outcomes in Advanced Heart Failure With High B-Type Natriuretic Peptide Level

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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