Abstract 13253: Race, Exercise Training and Outcomes in Chronic Heart Failure

Abstract

Background: The strength of race as a predictor of outcomes in a contemporary chronic heart failure (HF) population and its interaction with exercise training response remains unexplored.

Methods: We performed an analysis of HF-ACTION, which randomized 2,331 HF patients with EF <35% to usual care with or without long-term aerobic exercise training. We compared clinical characteristics and outcomes [mortality/hospitalization (hosp), mortality, cardiovascular (CV) mortality/CV hosp, and CV mortality/HF hosp] by race using adjusted Cox models and explored an interaction with exercise training. For the present analysis, we focused on the comparison of whites and African Americans (AA).

Results: Of patients with race documented, 62% (N=1426) were white, 33% (N=749) were AA and 5% (N=121) were other. Compared with whites, AAs were younger (median 55 vs. 62 yr), more often female (40% vs. 22%), and less often had ischemic HF (32% vs. 61%), but had a similar EF and creatinine. At baseline, AAs had a lower peak VO2 (raw median 13.2 vs. 15.0 mL/kg/min) and shorter 6-minute walk (raw median 348 vs. 383 meters) despite gender adjustment (both P<0.01). During a median follow-up of 2.5 yr, there was a statistically significant difference between the 3 race groups for the endpoints of mortality/hosp (P=0.032) and CV mortality/HF hosp (P=0.0002). After multivariable adjustment including education and income level, AA race was associated with increased CV mortality/CV hosp and CV mortality/HF hosp, but not increased mortality (Table). There was no significant interaction between race and exercise training on outcomes (all P>0.5).

Conclusion: AA race in chronic HF patients with reduced EF was associated with younger age, higher proportion of women and non-ischemic etiology, reduced baseline exercise capacity, and increased CV mortality/CV hosp and CV mortality/HF hosp, but not increased all-cause mortality or a differential response to exercise training on clinical outcomes.