Author + information
- Received September 11, 2017
- Accepted November 26, 2017
- Published online January 30, 2018.
- Alison M. Mudge, PhDa,b,∗ (, )
- Charles P. Denaro, MDa,b,
- Adam C. Scott, PhDc,
- Deborah Meyers, MDd,
- Julie A. Adsett, BPhty (Hons)e,
- Robert W. Mullins, MAppSci (Clin Ex Sci)f,
- Jessica M. Suna, MAppScia,f,
- John J. Atherton, PhDb,c,
- Thomas H. Marwick, PhDg,
- Paul Scuffham, PhDh and
- Peter O’Rourke, PhDi
- aDepartment of Internal Medicine and Aged Care, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- bUniversity of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
- cDepartment of Cardiology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- dTexas Heart Institute, Houston, Texas
- eHeart Support Service, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- fQueensland University of Technology, Brisbane, Queensland, Australia
- gBaker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- hCentre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- iStatistics Unit, QIMR Berghofer, Brisbane, Queensland, Australia
- ↵∗Address for correspondence:
Dr. Alison M. Mudge, Internal Medicine Research, Level 9 Ned Hanlon Building, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, Queensland 4029, Australia.
Objectives This study sought to measure the impact on all-cause death or readmission of adding center-based exercise training (ET) to disease management programs for patients with a recent acute heart failure (HF) hospitalization.
Background ET is recommended for patients with HF, but evidence is based mainly on ET as a single intervention in stable outpatients.
Methods A randomized, controlled trial with blinded outcome assessor, enrolling adult participants with HF discharged from 5 hospitals in Queensland, Australia. All participants received HF-disease management program plus supported home exercise program; intervention participants were offered 24 weeks of supervised center-based ET. Primary outcome was all-cause 12-month death or readmission. Pre-planned subgroups included age (<70 years vs. older), sex, left ventricular ejection fraction (≤40% vs. >40%), and exercise adherence.
Results Between May 2008 and July 2013, 278 participants (140 intervention, 138 control) were enrolled: 98 (35.3%) age ≥70 years, 71 (25.5%) females, and 62 (23.3%) with a left ventricular ejection fraction of >40%. There were no adverse events associated with ET. There was no difference in primary outcome between groups (84 of 140 [60.0%] intervention vs. 90 of 138 [65.2%] control; p = 0.37), but a trend toward greater benefit in participants age <70 years (OR: 0.56 [95% CI: 0.30 to 1.02] vs. OR: 1.56 [95% CI: 0.67 to 3.64]; p for interaction = 0.05). Participants who exercised to guidelines (72 of 101 control and 92 of 117 intervention at 3 months) had a significantly lower rate of death and readmission (91 of 164 [55.5%] vs. 41 of 54 [75.9%]; p = 0.008).
Conclusions Supervised center-based ET was a safe, feasible addition to disease management programs with supported home exercise in patients recently hospitalized with acute HF, but did not reduce combined end-point of death or readmission. (A supervised exercise programme following hospitalisation for heart failure: does it add to disease management?; ACTRN12608000263392)
The trial was funded by Australian National Health and Medical Research Council Project Grant number 498403 with contributions from the Royal Brisbane Hospital Foundation, Brisbane, Queensland, Australia (including a Patricia Dukes Fellowship award to Dr. Mudge) and the Prince Charles Hospital Foundation, Brisbane, Queensland, Australia. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 11, 2017.
- Accepted November 26, 2017.
- 2018 American College of Cardiology Foundation
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