Abstract 17587: Implications of Angina Pectoris on Quality of Life, Functional Capacity and Clinical Outcomes in Chronic Heart Failure Patients: Insights From HF-ACTION

Abstract

Background: Angina pectoris (AP) is associated with worse outcomes in heart failure (HF) patients, but less is known about implications on health related quality of life (HRQoL) and functional capacity. Methods: We assessed HRQoL, functional capacity and outcomes in chronic HF patients with reduced EF in the HF-ACTION trial of usual care +/- exercise training based on whether patients had AP. AP was patient-reported based on recent symptoms or development during exercise testing. We assessed all-cause mortality/hospitalization in patients with AP vs. no AP using multivariable Cox proportional hazards regression. We assessed for an interaction between AP status and exercise training with respect to outcomes and the change in quality of life and functional capacity from baseline to 3 months. Results: In HF-ACTION, 406 (17%) patients had AP at baseline with 44% of these reporting ≥ class II symptoms. Patients with AP more often had ischemic etiology, but had similar EF, NT-proBNP and beta-blocker use. Baseline 6-minute walk distance and peak VO 2 were similar in both groups, but patients with AP had worse depressive symptoms and HRQoL. After risk adjustment, AP was associated with a 22% greater risk of all-cause mortality/hospitalization (Figure). There was evidence of an interaction between baseline AP and exercise training on change in peak VO 2 (P=0.019), but not for HRQoL or clinical outcomes. The median change in peak VO 2 with exercise training was 0.8 mL/kg/min with AP vs. 0.6 mL/kg/min without AP. Conclusion: AP was associated with worse HRQoL and more depressive symptoms. Despite a greater improvement in peak VO 2 with exercise training, patients with AP experienced more adverse events. Clinicians should consider routine assessment and management of AP in HF patients as well as the associated symptoms related to depression and implications on quality of life.