Clinical InvestigationCongestive Heart FailureClinical 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)
Section snippets
Methods
The design, rationale, and primary results of the HF-ACTION study have been published.15, 16 Briefly, HF-ACTION was a randomized trial evaluating the effect of exercise training and usual care vs usual care alone on outcomes in patients with chronic HF (New York Heart Association classes II-IV, left ventricular ejection fraction [LVEF] ≤35%). The primary end point was mortality/hospitalization over a median follow-up of 2.5 years. An independent clinical events committee adjudicated CV
Results
Of patients with baseline determination of COPD status (n = 2311), 11% (n = 249) had COPD. Table I presents the baseline characteristics by COPD status. Patients with COPD were significantly older and with more ischemic etiology compared with those without COPD. Patients with COPD more often had hypertension, atrial fibrillation/flutter, and prior myocardial infarction. The COPD group had a similar LVEF to those without COPD. Blood pressure and heart rate were similar between those with and
Discussion
The prognosis for patients with COPD and HF has been conflicting,2, 3, 9, 10 and limited data exist with respect to the impact of exercise training and β-blocker selectivity on outcomes in this population. In HF-ACTION, the largest randomized trial of exercise training in stable patients with chronic HF and reduced EF,16 we demonstrated that COPD was associated with older age, an increased burden of comorbidities, worse baseline clinical status, and reduced exercise capacity. In the adjusted
Conclusion
Chronic obstructive pulmonary disease in patients with HF caused by systolic dysfunction was associated with older age, more comorbidities, worse clinical status, lower β-blocker use, reduced exercise capacity, and increased CV mortality/HF hospitalization, but not with the primary end point of mortality/hospitalization. We did not observe a differential response to aerobic exercise training in those with and without COPD. β-Blocker selectivity was not associated with differences in long-term
Disclosures
Conflict of interest: None.
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Cited by (0)
Funding support: HF-ACTION was funded by the National Heart, Lung, and Blood Institute. Dr Schulte was supported by National Institutes of Health grant P01 CA142538.
Javed Butler, MD MPH, Clinician-Investigator, CHF, served as guest editor for this article.