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Exercise training cuts heart failure mortality

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Exercise training underused in heart failure

These results are a step forward in confirming the safety and efficacy of exercise training for heart failure patients. It is a good addition to the literature. Its strength is its use of an analysis of individual patient data.

Dr. Theresa A. McDonagh

The findings deliver the important message that exercise rehabilitation is important for all heart failure patients. Currently, uptake of such programs is low, involving about 20% of heart failure patients.

The analysis showed a consistent effect from exercise training across all subgroups examined. The actual reductions in adverse outcomes were meaningful, with a 2% absolute reduction in all-cause mortality and a nearly 4% absolute reduction in all-cause hospitalization. However, the findings do not tell us which type of exercise prescription works best. Future research needs to especially focus on patients with heart failure with preserved ejection fraction to determine whether exercise benefits this particular type of heart failure patient.

Dr. Theresa A. McDonagh is a professor of heart failure at King’s College, London. She made these comments as the designated discussant for the study. She had no relevant financial disclosures.


 

AT HEART FAILURE 2016

References

FLORENCE, ITALY – Exercise training boosts the longevity of patients with heart failure.

Although results from several prior randomized, controlled trials had already shown a mortality benefit from exercise training for heart failure patients, these findings have now been confirmed by a meta-analysis that used the original, individual patient raw data collected in 20 separate randomized, controlled trials that together involved more than 4,000 patients. The results showed that an exercise-training intervention run for at least 3 weeks produced a statistically significant, relative reduction in all-cause mortality of 18%, compared with similar patients who had been randomized to usual care without an exercise program, Oriana Ciani, Ph.D., reported at a meeting held by the Heart Failure Association of the European Society of Cardiology.

Dr. Oriana Chiani Mitchel L. Zoler/Frontline Medical News

Dr. Oriana Chiani

The individual patient data meta-analysis using results from randomized, controlled trials also showed a statistically significant 11% relative reduction in the incidence of all-cause hospitalization in heart failure patients during at least 6 months’ follow-up of exercise programs that lasted for at least 3 weeks, said Dr. Ciani, a health technology researcher at the University of Exeter (England).

Her analysis also showed no suggestion of heterogeneity for each of these two beneficial effects from exercise programs, regardless of patients’ age, sex, or baseline levels of left ventricular ejection fraction, heart failure etiology, functional status, or exercise capacity. “No evidence was found to support a differential treatment effect from exercise-based intervention across patient subgroups,” she said.

The Exercise Training for Chronic Heart Failure (ExTraMATCH II) meta-analysis used data collected in randomized trials published through 2014 that involved at least 50 patients, used an exercise intervention for at least 3 weeks, and had follow-up for at least 6 months. Dr. Ciani and her associates identified 20 studies that included a total of 4,043 heart failure patients who fulfilled these criteria and for whom the researchers from the studies were willing to share individual patient data.

The analysis also showed a median time to all-cause mortality of 605 days among patients who received exercise training and 615 days in the controls, and a median time to first all-cause hospitalization of 229 days with exercise training and 241 days in the controls. The percentage of patients who were hospitalized during follow-up was reduced by an absolute 3.8% for those in the exercise group, compared with the controls.

Although the type of exercise intervention used varied among the 20 studies, most involved aerobic training, and some also used resistance training, Dr. Ciani said. She said she plans additional analyses of the data she has collected to examine the impact of exercise in heart failure patients on cardiovascular mortality, heart failure hospitalization, and a combined endpoint of all-cause death and all-cause hospitalization.

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