Race, exercise training, and outcomes in chronic heart failure

Findings from Heart Failure - A Controlled Trial Investigating Outcomes in Exercise TraiNing (HF-ACTION)

Robert J. Mentz, Vera Bittner, Phillip Schulte, Jerome L. Fleg, Ileana L. Piña, Steven J. Keteyian, Gordon Moe, Anil Nigam, Ann M. Swank, Anekwe E. Onwuanyi, Meredith Fitz-Gerald, Andrew Kao, Stephen J. Ellis, William E. Kraus, David J. Whellan, Christopher M. O'Connor

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalAmerican Heart Journal
Volume166
Issue number3
DOIs
StatePublished - Sep 2013
Externally publishedYes

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Heart Failure
Exercise
Mortality
Hospitalization
Proportional Hazards Models
Social Class
Hypertension
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Race, exercise training, and outcomes in chronic heart failure : Findings from Heart Failure - A Controlled Trial Investigating Outcomes in Exercise TraiNing (HF-ACTION). / Mentz, Robert J.; Bittner, Vera; Schulte, Phillip; Fleg, Jerome L.; Piña, Ileana L.; Keteyian, Steven J.; Moe, Gordon; Nigam, Anil; Swank, Ann M.; Onwuanyi, Anekwe E.; Fitz-Gerald, Meredith; Kao, Andrew; Ellis, Stephen J.; Kraus, William E.; Whellan, David J.; O'Connor, Christopher M.

In: American Heart Journal, Vol. 166, No. 3, 09.2013.

Research output: Contribution to journalArticle

Mentz, RJ, Bittner, V, Schulte, P, Fleg, JL, Piña, IL, Keteyian, SJ, Moe, G, Nigam, A, Swank, AM, Onwuanyi, AE, Fitz-Gerald, M, Kao, A, Ellis, SJ, Kraus, WE, Whellan, DJ & O'Connor, CM 2013, 'Race, exercise training, and outcomes in chronic heart failure: Findings from Heart Failure - A Controlled Trial Investigating Outcomes in Exercise TraiNing (HF-ACTION)', American Heart Journal, vol. 166, no. 3. https://doi.org/10.1016/j.ahj.2013.06.002
Mentz, Robert J. ; Bittner, Vera ; Schulte, Phillip ; Fleg, Jerome L. ; Piña, Ileana L. ; Keteyian, Steven J. ; Moe, Gordon ; Nigam, Anil ; Swank, Ann M. ; Onwuanyi, Anekwe E. ; Fitz-Gerald, Meredith ; Kao, Andrew ; Ellis, Stephen J. ; Kraus, William E. ; Whellan, David J. ; O'Connor, Christopher M. / Race, exercise training, and outcomes in chronic heart failure : Findings from Heart Failure - A Controlled Trial Investigating Outcomes in Exercise TraiNing (HF-ACTION). In: American Heart Journal. 2013 ; Vol. 166, No. 3.
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abstract = "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.",
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AU - Schulte, Phillip

AU - Fleg, Jerome L.

AU - Piña, Ileana L.

AU - Keteyian, Steven J.

AU - Moe, Gordon

AU - Nigam, Anil

AU - Swank, Ann M.

AU - Onwuanyi, Anekwe E.

AU - Fitz-Gerald, Meredith

AU - Kao, Andrew

AU - Ellis, Stephen J.

AU - Kraus, William E.

AU - Whellan, David J.

AU - O'Connor, Christopher M.

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N2 - 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.

AB - 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.

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