Abstract
Patients with chronic heart failure (CHF) experience progressive deterioration of functional capacity and quality of life (QoL). This prospective, randomized, controlled trial assesses the effect of exercise training (ET) protocol on functional capacity, rehospitalization, and QoL in CHF patients older than 70 years compared with a control group. A total of 343 elderly patients with stable CHF (age, 76.90±5.67, men, 195, 56.9%) were randomized to ET (TCG, n=170) or usual care (UCG, n=173). The ET protocol involved supervised training sessions for 3 months in the hospital followed by home-telemonitored sessions for 3 months. Assessments, performed at baseline and at 3 and 6 months, included: ECG, resting echocardiography, NT-proBNP, 6-minute walk test (6MWT), Minnesota Living with Heart Failure Questionnaire, and comprehensive geriatric assessment with the InterRAI-HC instrument. As compared to UCG, ET patients at 6 months showed: i) significantly increased 6MWT distance (450±83 vs. 290±97 m, p<0.001); ii) increased ADL scores (5.00±2.49 vs. 6.94±5.66, p=0.037); iii) 40% reduced risk of rehospitalisation (hazard ratio=0.558, 95%CI, 0.326-0.954, p=0.033); and iv) significantly improved perceived QoL (28.6±12.3 vs. 44.5±12.3, p<0.001). In hospital and home-based telemonitored exercise confer significant benefits on the oldest CHF patients, improving functional capacity and subjective QoL and reducing risk of rehospitalisation.
Highlights
Congestive heart failure (CHF) is a disabling syndrome affecting 1–2% of the adult western population
As regards the cause of CHF, 49% was due to ischemia, 36% to hypertension, and 15% to valve defects
Our findings provide fresh evidence for the value of exercise training (ET) in elderly subjects with CHF, by demonstrating that in this subset of CHF patients the benefits of exercise add to those provided by common medications
Summary
Congestive heart failure (CHF) is a disabling syndrome affecting 1–2% of the adult western population. The proportion of elderly patients with CHF is set to rise as a consequence of three main factors: extended average life expectancy, enhanced response rates to treatments, and longer survival after acute cardiovascular events [2,3,4]. Even though emerging evidence shows that exercise in adult CHF patients is associated with improvements in symptoms, exercise tolerance, and quality of life (QoL), which ameliorate clinical outcomes [5], the approach is still far from widespread. The data reported by HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), describes non-significant reductions in the primary endpoint (all-cause mortality or hospitalization) and in key secondary clinical endpoints [6]
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