Why the study?
Although exercise training is an established adjunct treatment for chronic heart failure, the influence of baseline medications or disease conditions on its effectiveness has not been fully explored.
Does exercise training improve all-cause death in patients with chronic heart failure with reduced ejection fraction depending on baseline medications?
Does exercise training improve all-cause death in patients with chronic heart failure with reduced ejection fraction depending on baseline medications?
The benefits of exercise training in HFrEF depend heavily on baseline medical therapy, with increased mortality risk observed in patients not taking beta-blockers.
Exercise may lower mortality risk with beta-blockers plus RAS inhibitors but raise it without beta-blockers in HFrEF; hypothesis-generating, needs RCTs before practice change.
Background Exercise training is an accepted evidence-based adjunct treatment modality for patients with chronic heart failure. However, the influence of medications or conditions on exercise has not been fully explored. Methods The patient records of the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) study were obtained from the National Heart, Lung, and Blood Institute, and analyzed by medications used at baseline (renin-angiotensin system inhibitors [RASIs], beta-blockers [BBs], and combination of both) with multivariable Cox regression models focusing on the interactions with exercise effects, and a score to indicate exercise training suitability was proposed accordingly. Results Medication type strongly influenced the exercise effect on all-cause death (AD) (P = 0.007) even though medication itself did not change prognosis significantly in HF-ACTION trial. In patients taking both BBs and RASIs at baseline, exercise reduced the AD risk (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.75–0.98), whereas in patients not taking BBs, exercise increased the risk (HR, 4.58; 95% CI, 2.90–6.86). The exercise on AD was also influenced by pulse pressure, hemoglobin level, electrocardiography conditions, body mass index, and history of stroke. Accordingly, we constructed the Score for Eligibility of Exercise on Mortality (SEEM). When exercise training was chosen based on SEEM score, both AD and AD and hospitalization (ADH) risks were expected to reduce significantly (HR, 0.54; 95% CI, 0.44–0.68; HR, 0.83; 95% CI, 0.75–0.93, respectively). Conclusions Exercise training in patients with heart failure should be recommended carefully with consideration of patient background. Clinical Trial Registration Clinicaltrials.gov identifier: NCT00047437 . Trial registration date: 4 October 2002.
No takes yet. Share an insight, caveat, or question.
Soejima et al. (2022) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: