Absence of Fitness Improvement Is Associated with Outcomes in Heart Failure Patients

PURPOSETo examine the clinical impact of cardiorespiratory fitness (CRF) and improvements in CRF after cardiac rehabilitation (CR) in heart failure (HF) patients for their risk of all-cause mortality and unplanned hospitalization. Secondly, to investigate possible factors associated with the absence of improvement in CRF after rehabilitation. METHODSWe included 155 HF patients receiving CR between October 2009 and January 2015. Patients performed an incremental bicycle test to assess CRF through peak oxygen uptake (VO2-peak) before and after CR-based supervised exercise training. Patients were classified as responders or non-responders based on pre-to-post CR changes in VO2-peak (≥6% and <6%, respectively). Cox proportional hazards models evaluated all-cause mortality and unplanned hospitalization during 5 years of follow-up. Patient characteristics, HF features and co-morbidities were used to predict changes in VO2-peak using logistic regression analysis. RESULTSSeventy HF patients (45%) were classified as responder. Non-responders had a significantly higher risk of all-cause mortality or hospitalization (HR = 2.15, 95% CI = 1.17-3.94) compared to responders. This was even higher in non-responders with low CRF at baseline (HR = 4.88, 95% CI = 1.71-13.93). Factors associated with non-response to CR were age (OR = 1.07/year, 95% CI = 1.03-1.11), baseline VO2-peak (OR = 1.16/ml/min/kg, 95% CI = 1.06-1.26) and adherence to CR (OR = 0.98/percentage, 95% CI = 0.96-0.998). CONCLUSIONIndependent from baseline CRF, the inability to improve VO2-peak by CR doubled the risk of death or unplanned hospitalization. The combination of lower baseline CRF and non-response was associated with even poorer clinical outcomes. Especially older HF patients with higher baseline VO2-peak and lower adherence have a higher probability of becoming a non-responder..

Medienart:	Artikel

Erscheinungsjahr:	2017
Erschienen:	2017

Enthalten in:	Zur Gesamtaufnahme - year:2017
Enthalten in:	Medicine and science in sports and exercise - (2017)

Sprache:	Englisch

Beteiligte Personen:	Bakker, Esmée A [VerfasserIn] Snoek, Johan A [Sonstige Person] Meindersma, Esther P [Sonstige Person] Hopman, Maria T.E [Sonstige Person] Bellersen, Louise [Sonstige Person] Verbeek, André L.M [Sonstige Person] Thijssen, Dick H.J [Sonstige Person] Eijsvogels, Thijs M.H [Sonstige Person]

Links:	Volltext

doi:	10.1249/MSS.0000000000001429

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	OLC1996907611