Physical Activity and Prognosis in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) Trial
Background—Physical activity (PA) is inversely associated with adverse cardiovascular (CV) outcomes in healthy populations but the impact of physical activity in patients with heart failure with preserved ejection fraction (HFpEF) is less well characterized.
Methods—The baseline self-reported PA of 1751 subjects enrolled in the Americas region of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial was categorized as poor, intermediate, or ideal PA using American Heart Association (AHA) criteria. PA was related to the primary composite outcome (heart failure [HF] hospitalization, CV mortality, or aborted cardiac arrest), its components, and all-cause mortality using multivariable Cox models.
Results—The mean age at enrollment was 68.6 ± 9.6 years. Few patients met AHA criteria for ideal activity (11% ideal, 14% intermediate, 75% poor). Over a median follow-up of 2.4 years, the primary composite outcome occurred in 519 patients (397 HF hospitalizations, 222 CV deaths, and 6 aborted cardiac arrests). Compared to those with ideal baseline PA, poor and intermediate baseline PA were associated with a greater risk of the primary outcome (HR 2.05; 95% CI, 1.28-3.28; HR 1.95; CI, 1.15-3.33, respectively), HF hospitalization (HR 1.93; CI, 1.16-3.22; HR 1.84; CI, 1.02-3.31), CV mortality (HR 4.36; CI, 1.37-13.83; HR 4.05; CI 1.17-14.04), and all-cause mortality (HR 2.95; CI, 1.44-6.02; HR 2.05; CI 0.90, 4.67) after multivariable adjustment for potential confounders.
Conclusions—In patients with HFpEF, both poor and intermediate self-reported PA were associated with higher risk of HF hospitalization and mortality.
Clinical Trials Registration—URL: https://clinicaltrials.gov/ Unique Identifier: NCT00094302.
- Received February 20, 2017.
- Revision received June 6, 2017.
- Accepted June 12, 2017.