Abstract 13704: Leisure Activity is Associated With Prognosis in Heart Failure With Preserved Ejection Fraction - Results From the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial

Abstract

Background: Leisure-time physical activity is inversely associated with cardiovascular (CV) outcomes in healthy populations but the impact of leisure activity in heart failure with preserved ejection fraction (HFpEF) is unknown. We hypothesized that poor leisure activity predicts CV outcomes in HFpEF patients. Methods: The baseline self-reported physical activities of 1751 subjects from the Americas region of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial were categorized as poor, intermediate, or ideal by American Heart Association (AHA) criteria. Leisure activity 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 was 71.5 ± 9.7 years. Few patients met AHA criteria for ideal activity (11.0% ideal, 14.0% intermediate, 74.9% poor). Over a median follow-up of 2.4 years, the primary composite outcome occurred in 519 patients with a total of 397 HF hospitalizations, 222 CV deaths, and 6 aborted cardiac arrests. Compared to those with ideal activity, poor baseline activity was associated with a greater risk of the primary outcome (HR 1.53; 95% CI, 1.10-2.13), HF hospitalization (HR 1.65; CI, 1.12-2.44) (Figure), CV mortality (HR 1.38; CI, 0.86-2.23), and all-cause mortality (HR 1.70; CI, 1.16-2.50) after multivariable adjustment for potential confounders. A dose-response relationship was also present such that those with the least activity demonstrated highest risk of the primary composite outcome, HF hospitalization, and all-cause mortality (p for trend all ≤ 0.01). Conclusions: In patients with HFpEF, poor baseline leisure activity is associated with higher risk of HF hospitalization and mortality.