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Afib, Heart Failure, and Exercise

Afib, Heart Failure, and Exercise

  • HF-ACTION: Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training

  • The prognosis of comorbid Afib and heart failure is worse than either one alone. Current study looked at the impact of systematic exercise in patients with AF and HFrEF in stable outpatients from HF-ACTION study cohort. (MI, myocardial infarction; OSA, obstructive sleep apnea; HTN, hypertension)

  • HF-ACTION: Patients with HFrEF (EF less than 35%), NYHA Class II-IV symptoms; safety/efficacy of exercise training w CHF meds vs CHF meds alone. Goal: initially 90 min/wk for 3 mo, eventually 120 min/wk. (RCT, randomized controlled trial; NYHA, New York Heart Association, CHF, congestive heart failure)

  • HF-ACTION Results (DM, diabetes mellitus; KCCQ, Kansas City cardiomyopathy questionnaire)

  • HF-ACTION Conclusions: In HF patients with AF, exercise training is not associated with fewer AF events (hospitalization due to AF or SAE for symptomatic AF).

  • HF-ACTION Interpretation: Exercise in AF with HFrEF is safe and results in a positive functional response similar to SR patients.

  • HF-ACTION Next Steps: Additional RCTs are needed to determine if response to exercise is heterogeneous amongst HFrEF patients and whether clinical predictors can be used to determine which patients are likely to benefit the most.

The HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) study evaluated the safety and efficacy of exercise training in heart failure patients with atrial fibrillation. Clinical characteristics and outcomes (mortality/hospitalizations) were assessed by baseline AF status: past history of AF or AF on baseline electrocardiogram vs no AF).

Click through this short slide show for a topline review of study methods, results, and interpretation. Additional study notes below.

Additional Notes:

 -- n=308 (13%) of patient excluded due to “other” rhythm

 -- Overall, mean age was ~59y, 30% female, 60% white, 34% black.

 -- All patients >90% use of beta-blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers at baseline.

 -- Adjustment for dosage of beta-blocker, KCCQ symptom stability, LVEF, country, sex, ventricular conduction, Weber class, blood urea nitrogen, and mitral regurgitation.

Link to study abstract:

Luo N, Merrill P, Parikh KS, et al. Exercise training in patients with chronic heart failure and atrial fibrillation. J Am Coll Cardiol. 2017 Apr 4;69:1683-1691. doi: 10.1016/j.jacc.2017.01.032.

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