Race, exercise training, and outcomes in chronic heart failure: Findings from Heart Failure - A Controlled Trial Investigating Outcomes in Exercise TraiNing (HF-ACTION) - 07/09/13
, Vera Bittner, MD, MSPH b, Phillip J. Schulte, PhD c, Jerome L. Fleg, MD d, Ileana L. Piña, MD, MPH e, Steven J. Keteyian, PhD f, Gordon Moe, MD g, Anil Nigam, MD, MSc h, Ann M. Swank, PhD i, Anekwe E. Onwuanyi, MD j, Meredith Fitz-Gerald, RN, BSN b, Andrew Kao, MD k, Stephen J. Ellis, PhD c, William E. Kraus, MD a, David J. Whellan, MD, MHS l, Christopher M. O'Connor, MD aRiassunto |
Background |
The strength of race as an independent predictor of long-term outcomes in a contemporary chronic heart failure (HF) population and its association with exercise training response have not been well established. We aimed to investigate the association between race and outcomes and to explore interactions with exercise training in patients with ambulatory HF.
Methods |
We performed an analysis of HF-ACTION, which randomized 2331 patients with HF having an ejection fraction ≤35% to usual care with or without exercise training. We examined characteristics and outcomes (mortality/hospitalization, mortality, and cardiovascular mortality/HF hospitalization) by race using adjusted Cox models and explored an interaction with exercise training.
Results |
There were 749 self-identified black patients (33%). Blacks were younger with significantly more hypertension and diabetes, less ischemic etiology, and lower socioeconomic status versus whites. Blacks had shorter 6-minute walk distance and lower peak VO2 at baseline. Over a median follow-up of 2.5 years, black race was associated with increased risk for all outcomes except mortality. After multivariable adjustment, black race was associated with increased mortality/hospitalization (hazard ratio [HR] 1.16, 95% CI 1.01-1.33) and cardiovascular mortality/HF hospitalization (HR 1.46, 95% CI 1.20-1.77). The hazard associated with black race was largely caused by increased HF hospitalization (HR 1.58, 95% CI 1.27-1.96), given similar cardiovascular mortality. There was no interaction between race and exercise training on outcomes (P > .5).
Conclusions |
Black race in patients with chronic HF was associated with increased prevalence of modifiable risk factors, lower exercise performance, and increased HF hospitalization, but not increased mortality or a differential response to exercise training.
Il testo completo di questo articolo è disponibile in PDF.Mappa
| Hector O. Ventura, MD served as guest editor for this article. |
Vol 166 - N° 3
P. 488 - settembre 2013 Ritorno al numero
Articolo precedente
- Prognostic importance of coronary anatomy and left ventricular ejection fraction despite optimal therapy: Assessment of residual risk in the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation Trial
- G.B. John Mancini, Pamela M. Hartigan, Eric R. Bates, Bernard R. Chaitman, Steven P. Sedlis, David J. Maron, William J. Kostuk, John A. Spertus, Koon K. Teo, Marcin Dada, Merril Knudtson, Daniel S. Berman, David C. Booth, William E. Boden, William S. Weintraub
- Implantable cardioverter-defibrillators in hypertrophic cardiomyopathy: Patient outcomes, rate of appropriate and inappropriate interventions, and complications
- Pieter A. Vriesendorp, Arend F.L. Schinkel, Johan Van Cleemput, Rik Willems, Luc J.L.M. Jordaens, Dominic A.M.J. Theuns, Marjon A. van Slegtenhorst, Thomy J. de Ravel, Folkert J. ten Cate, Michelle Michels
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
L'accesso al testo integrale di questo articolo richiede un abbonamento.
Già abbonato a @@106933@@ rivista ?