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JACC Heart Fail. 2018 Feb;6(2):143-152. doi: 10.1016/j.jchf.2017.11.016.

Addition of Supervised Exercise Training to a Post-Hospital Disease Management Program for Patients Recently Hospitalized With Acute Heart Failure: The EJECTION-HF Randomized Phase 4 Trial.

Author information

1
Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia. Electronic address: Alison.Mudge@health.qld.gov.au.
2
Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia.
3
Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
4
Texas Heart Institute, Houston, Texas.
5
Heart Support Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
6
Queensland University of Technology, Brisbane, Queensland, Australia.
7
Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Queensland University of Technology, Brisbane, Queensland, Australia.
8
University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia; Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
9
Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
10
Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
11
Statistics Unit, QIMR Berghofer, Brisbane, Queensland, Australia.

Abstract

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).

KEYWORDS:

disease management; exercise training; heart failure

PMID:
29413370
DOI:
10.1016/j.jchf.2017.11.016
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