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 J.; Fleg, Jerome L.; Piña, Ileana L.; Keteyian, Steven J.; Moe, Gordon W.; Nigam, Anil; Swank, Ann M.; Onwuanyi, Anekwe; Fitz-Gerald, Meredith B.; Kao, Andrew; Ellis, Stephen J.; Kraus, William E.; Whellan, David J.; O’Connor, Christopher M.

doi:10.1016/j.ahj.2013.06.002

Cited by 33 publications

(20 citation statements)

References 30 publications

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“…21 We found that the vast majority of Jackson Heart Study participants with QRS prolongation had a QRS duration of 100 to 119 msec (ie, 89% of prolongation cases). These findings support previous research suggesting important differences in ventricular conduction by race 10,22,23 and highlight the high prevalence of mild QRS prolongation in African Americans. Genetic differences may explain, in part, these racial differences in QRS duration.…”

Section: Discussionsupporting

confidence: 91%

“…3,8 Racial differences in ventricular conduction have been identified in the general population and among patients with cardiac disease. 9,10 However, associations between QRS duration and clinical outcomes in African Americans have not been well characterized. The availability of electrocardiogram information on more than 5000 African American participants in the Jackson Heart Study allows a comprehensive investigation of the relationship between QRS duration and mortality in this population.…”

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confidence: 99%

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Ventricular Conduction and Long-Term Heart Failure Outcomes and Mortality in African Americans

Mentz

Greiner

DeVore

et al. 2015

Circ: Heart Failure

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Background QRS prolongation is associated with adverse outcomes in mostly white populations, but its clinical significance is not well established for other groups. We investigated the association between QRS duration and mortality in African Americans. Methods and Results We analyzed data from 5146 African Americans in the Jackson Heart Study stratified by QRS duration on baseline 12-lead electrocardiogram. We defined QRS prolongation as QRS ≥ 100 msec. We assessed the association between QRS duration and all-cause mortality using Cox proportional hazards models, and reported the cumulative incidence of heart failure (HF) hospitalization. We identified factors associated with the development of QRS prolongation in patients with normal baseline QRS. At baseline, 30% (n = 1528) of participants had QRS prolongation. The cumulative incidences of mortality and HF hospitalization were greater with versus without baseline QRS prolongation: 12.6% (95% CI, 11.0–14.4) vs. 7.1% (95% CI, 6.3–8.0) and 8.2% (95% CI, 6.9–9.7) vs. 4.4% (95% CI, 3.7–5.1), respectively. After risk adjustment, QRS prolongation was associated with increased mortality (HR, 1.27; 95% CI, 1.03–1.56; P = .02). There was a linear relationship between QRS duration and mortality (HR per 10 msec increase, 1.06; 95% CI, 1.01–1.12). Older age, male sex, prior myocardial infarction, lower ejection fraction, left ventricular hypertrophy, and left ventricular dilatation were associated with the development of QRS prolongation. Conclusions QRS prolongation in African Americans was associated with increased mortality and HF hospitalization. Factors associated with developing QRS prolongation included age, male sex, prior myocardial infarction, and left ventricular structural abnormalities.

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

Ventricular Conduction and Long-Term Heart Failure Outcomes and Mortality in African Americans

Mentz

Greiner

DeVore

et al. 2015

Circ: Heart Failure

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“…Lastly, it appears that the highest rates of rehospitalization in these patients occurred despite their objective measures of milder HF; this implies that therapies aimed at improving disease state alone would not decrease these patients’ rehospitalization rates. Rather, a focused effort on understanding the global reasons for rehospitalization might result in more effective preventive methods (31,32). …”

Section: Discussionmentioning

confidence: 99%

Clinical Implications of Chronic Heart Failure Phenotypes Defined by Cluster Analysis

Ahmad

Pencina

Schulte

et al. 2014

Journal of the American College of Cardiology

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BACKGROUND Classification of chronic heart failure (HF) is based on criteria that may not adequately capture disease heterogeneity. Improved phenotyping may help inform research and therapeutic strategies. OBJECTIVE This study used cluster analysis to explore clinical phenotypes in chronic HF patients. METHODS A cluster analysis was performed on 45 baseline clinical variables from 1,619 participants in HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), evaluating exercise training versus usual care in chronic systolic HF. Association between identified clusters and clinical outcomes was performed using Cox proportional hazards modeling. Differential associations between clinical outcomes and exercise testing were examined using interaction testing. RESULTS Ranging in size from 248 to 773, four clusters were identified whose patients varied considerably along measures of age, sex, race, symptoms, comorbidities, HF etiology, socioeconomic status, quality of life, cardiopulmonary exercise testing parameters, and biomarker levels. Differential associations were observed for hospitalization and mortality risks between and within clusters. To illustrate, compared with cluster 1, risk of all-cause mortality/all-cause hospitalization ranged from 0.65 (0.54 to 0.78) for cluster 4 to 1.02 (0.87 to 1.19) for cluster 3. However, for all-cause mortality, cluster 3 had disproportionately lower risk 0.61 (0.44 to 0.86). Evidence suggested differential effects of exercise treatment on changes in peak VO2 and clinical outcomes between clusters (p for interaction <0.04). CONCLUSIONS Cluster analysis of clinical variables identified 4 distinct phenotypes of chronic HF. Our findings underscore the high degree of disease heterogeneity that exists within chronic HF patients and a need for improved phenotyping.

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“…The primary outcomes for the present analysis were change in peak VO 2 and change in KCCQ from baseline to 3 months, as in previous HF-ACTION analyses, because of the increased missingness at later time points (15,16). The secondary outcome was change in 6MWD from baseline to 3 months.…”

Section: Methodsmentioning

confidence: 99%

“…To account for the missing data at 3 months for the outcomes of interest, inverse weighting for missingness was performed. Specifically, subjects in the regression model were weighted by the inverse of their probability of having a nonmissing response similar to recent analyses in HF-ACTION (15,16). This should reduce the bias that would have been present in a complete case analysis by assigning higher weight to observed data subjects who were similar to subjects who were more likely to have missing data (15).…”

Section: Methodsmentioning

confidence: 99%

Statins and Exercise Training Response in Heart Failure Patients

Kelly

Dunning

Schulte

et al. 2016

JACC: Heart Failure

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OBJECTIVES The aim of this study was to assess for a treatment interaction between statin use and ET response. BACKGROUND Recent data suggest that statins may attenuate exercise training (ET) response, but limited data exist in patients with heart failure (HF). METHODS HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) was a randomized trial of 2,331 patients with chronic HF with ejection fraction ≤35% who were randomized to usual care with or without ET. We evaluated whether there was a treatment interaction between statins and ET response for the change in quality of life and aerobic capacity (peak oxygen consumption and 6-min walk distance) from baseline to 3 months. We also assessed for a treatment interaction among atorvastatin, simvastatin, and pravastatin and change in these endpoints with ET. Multiple linear regression analyses were performed for each endpoint, adjusting for baseline covariates. RESULTS Of 2,331 patients in the HF-ACTION trial, 1,353 (58%) were prescribed statins at baseline. Patients treated with statins were more likely to be older men with ischemic HF etiology but had similar use of renin angiotensin system blockers and beta-blockers. There was no evidence of a treatment interaction between statin use and ET on changes in quality of life or exercise capacity, nor was there evidence of differential association between statin type and ET response for these endpoints (all p values >0.05). CONCLUSIONS In a large chronic HF cohort, there was no evidence of a treatment interaction between statin use and short-term change in aerobic capacity and quality of life with ET. These findings contrast with recent reports of an attenuation in ET response with statins in a different population, highlighting the need for future prospective studies. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437)

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Race, exercise training, and outcomes in chronic heart failure: Findings from Heart Failure - A Controlled Trial Investigating Outcomes in Exercise TraiNing (HF-ACTION)

Cited by 33 publications

References 30 publications

Ventricular Conduction and Long-Term Heart Failure Outcomes and Mortality in African Americans

Ventricular Conduction and Long-Term Heart Failure Outcomes and Mortality in African Americans

Clinical Implications of Chronic Heart Failure Phenotypes Defined by Cluster Analysis

Statins and Exercise Training Response in Heart Failure Patients

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