Elsevier

American Heart Journal

Volume 165, Issue 2, February 2013, Pages 193-199
American Heart Journal

Clinical Investigation
Congestive Heart Failure
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)

https://doi.org/10.1016/j.ahj.2012.10.029Get rights and content

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 Ve/Vco2 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.

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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    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.

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