Abstract 11886: Effects of Exercise Training on Outcomes in Women with Heart Failure: Analysis of the HF-ACTION Trial by Gender
Rationale: There is less evidence for the benefit of exercise training (ET) in women with heart failure (HF) compared to men due to small numbers of women studied. We hypothesized that women enrolled in HF-ACTION and randomized to ET would improve functional capacity as measured by peak VO2 compared to those in the control group and that the improvement in peak VO2 would correlate with prognosis.
Methods_HF-ACTION was a randomized trial of ET vs. usual care in 2331 patients (pts) with Class II-IV HF and a LVEF of ≤ 35%. Gender differences in the effects of randomized treatment on clinical outcomes were assessed using a series of Cox proportional hazards models controlling for covariates known to affect prognosis in HF-ACTION.
Results: Of the 2,331 pts in HF-ACTION, 28% were women. Women vs. men: Age, 57 vs.60 y.o.; NYHA Class II, 62% vs. 64%; Ischemic, 32% vs. 59%; Serum Cr 1.0 vs. 1.3 mg/dL. Average EF (25%), was similar for women and men. Median beta blocker doses were lower in women (25 vs. 37 mg/day carvedilol equivalents). Women had lower baseline peak VO2 and 6-min walk distance than men (13.4 vs. 14.9 ml/min/kg and 353 vs. 378 m, respectively). An ET-related increase in peak VO2 at 3 mos.was present in both women and men in the ET group (0.88 + 2.2, 0.80 and 0.77 + 2.7, 0.60 mean + SD, median, respectively, women vs. men, p=0.42). The Table illustrates the estimated effect of treatment on outcomes by gender, after adjustment for covariates from previously developed models. Women randomized to ET had a significant reduction in the primary endpoint, compared to men randomized to ET, with a significant treatment-by-gender interaction (p=0.027). For all secondary endpoints, the HR was lower in women compared to men although the associated treatment-by-gender interactions were not statistically significant.
Conclusion: ET in women with HF reduces the combined endpoint of all cause mortality and hospitalizations to a greater extent than in men, despite similar baseline risk.
- © 2012 by American Heart Association, Inc.