Document Detail

Clinical characteristics, response to exercise training, and outcomes in patients with heart failure and chronic obstructive pulmonary disease: findings from Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION).
MedLine Citation:
PMID:  23351822     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The aim of this study was to investigate the clinical characteristics, exercise training response, β-blocker selectivity, and outcomes in patients with heart failure (HF) and chronic obstructive pulmonary disease (COPD).
METHODS: We performed an analysis of HF-ACTION, which randomized 2,331 patients with HF having an ejection fraction of ≤35% to usual care with or without aerobic exercise training. We examined clinical characteristics and outcomes (mortality/hospitalization, mortality, cardiovascular [CV] mortality/CV hospitalization, and CV mortality/HF hospitalization) by physician-reported COPD status using adjusted Cox models and explored an interaction with exercise training. The interaction between β-blocker cardioselectivity and outcomes was investigated.
RESULTS: Of patients with COPD status documented (n = 2311), 11% (n = 249) had COPD. Patients with COPD were older, had more comorbidities, and had lower use of β-blockers compared with those without COPD. At baseline, patients with COPD had lower peak oxygen consumption and higher V(E)/V(CO)(2) slope. During a median follow-up of 2.5 years, COPD was associated with increased mortality/hospitalization, mortality, and CV mortality/HF hospitalization. After multivariable adjustment, the risk of CV mortality/HF hospitalization remained increased (hazard ratio [HR] 1.46, 95% CI 1.14-1.87), whereas mortality/hospitalization (HR 1.15, 95% CI 0.96-1.37) and mortality (HR 1.33, 95% CI 0.99-1.76) were not significantly increased. There was no interaction between COPD and exercise training on outcomes or between COPD and β-blocker selectivity on mortality/hospitalization (all P > .1).
CONCLUSIONS: Chronic obstructive pulmonary disease in patients with HF was associated with older age, more comorbidities, reduced exercise capacity, and increased CV mortality/HF hospitalization, but not a differential response to exercise training. β-Blocker selectivity was not associated with differences in outcome for patients with vs without COPD.
Robert J Mentz; Phillip J Schulte; Jerome L Fleg; Mona Fiuzat; William E Kraus; Ileana L Piña; Steven J Keteyian; Dalane W Kitzman; David J Whellan; Stephen J Ellis; Christopher M O'Connor
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2012-11-28
Journal Detail:
Title:  American heart journal     Volume:  165     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-28     Completed Date:  2013-03-21     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  193-9     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Mosby, Inc. All rights reserved.
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MeSH Terms
Exercise / physiology*
Exercise Therapy / methods*
Follow-Up Studies
Heart Failure / mortality,  physiopathology,  rehabilitation*
Middle Aged
Proportional Hazards Models
Prospective Studies
Pulmonary Disease, Chronic Obstructive / mortality,  physiopathology,  rehabilitation*
Stroke Volume
Survival Rate
Treatment Outcome
United States / epidemiology
Grant Support
P01 CA142538/CA/NCI NIH HHS; P01 CA142538/CA/NCI NIH HHS

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