Abstract 19679: Peripheral Artery Disease is Associated with Worse Functional and Clinical Outcomes in Heart Failure Patients: HF-ACTION substudy
Background: Patients with peripheral artery disease (PAD) have lower functional capacity and worse clinical outcomes than matched controls. Few published data exist to describe how a concomitant diagnosis of PAD influences functional and clinical outcomes in heart failure (HF) patients. HF patients with and without PAD were compared for baseline functional capacity, response to exercise training, and clinical outcomes.
Methods: The HF-ACTION study was a randomized controlled trial evaluating usual care plus structured exercise training vs. usual care alone in HF patients with a left ventricular ejection fraction ≤ 35% and NYHA class II – IV heart failure symptoms. Cardiopulmonary exercise (CPX) testing occurred at enrollment, 3 months and 1 year. Clinical follow-up occurred for 4 years.
Results: Of the 2331 HF-ACTION patients, 2320 patients had baseline data on PAD and 157 patients carried a diagnosis of PAD. Baseline demographics and exercise testing results, response to exercise testing, and clinical outcomes are shown in Table 1. At baseline, HF patients with PAD had a lower exercise duration, lower peak oxygen consumption (VO2), and shorter six minute walking distance when compared to HF patients without PAD. At three months, HF patients with PAD had less improvement on CPX testing [exercise duration (mean modelled change; 0.5 vs. 1.1 minutes; p=0.002), six minute walking distance (mean change; 10.1 vs. 14.4 meters; p=NS), and peak VO2 (mean change; 0.1 vs. 0.6 mL/kg/min; p=0.04)] when compared to HF patients without PAD. PAD was an independent predictor of all-cause death and hospitalization [hazard ratio (CI); 1.31 (1.06 – 1.62), p=0.011].
Conclusions: PAD patients had worse baseline exercise capacity and poorer response to exercise training. PAD was an independent predictor of all-cause death and hospitalization in HF patients during this study. Further investigation into the association of PAD and HF in patients undergoing exercise training is warranted.
- © 2010 by American Heart Association, Inc.