The impact of physical inactivity on heart failure (HF) mortality is unclear. We analyzed
data from the HF Adherence and Retention Trial (HART) which enrolled 902 patients
with New York Heart Association class II/III HF, with preserved or reduced ejection
fraction, who were followed for 36 months. On the basis of mean self-reported weekly
exercise duration, patients were classified into inactive (0 min/week) and active
(≥1 min/week) groups and then propensity score matched according to 34 baseline covariates
in 1:2 ratio. Sedentary activity was determined according to self-reported daily television
screen time (<2, 2 to 4, >4 h/day). The primary outcome was all-cause death. Secondary
outcomes were cardiac death and HF hospitalization. There were 196 inactive patients,
of whom 171 were propensity matched to 342 active patients. Physical inactivity was
associated with greater risk of all-cause death (hazard ratio [HR] 2.01, confidence
interval [CI] 1.47 to 3.00; p <0.001) and cardiac death (HR 2.01, CI 1.28 to 3.17;
p = 0.002) but no significant difference in HF hospitalization (p = 0.548). Modest
exercise (1 to 89 min/week) was associated with a significant reduction in the rate
of death (p = 0.003) and cardiac death (p = 0.050). Independent of exercise duration
and baseline covariates, television screen time (>4 vs <2 h/day) was associated with
all-cause death (HR 1.65, CI 1.10 to 2.48; p = 0.016; incremental chi-square = 6.05;
p = 0.049). In conclusion, in patients with symptomatic chronic HF, physical inactivity
is associated with higher all-cause and cardiac mortality. Failure to exercise and
television screen time are additive in their effects on mortality. Even modest exercise
was associated with survival benefit.
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Article Info
Publication History
Published online: January 18, 2016
Accepted:
December 30,
2015
Received in revised form:
December 30,
2015
Received:
November 3,
2015
Footnotes
Funding: The Heart Failure Adherence and Retention Trial (NCT00018005) was funded by the National Heart, Lung, and Blood Institute ( HL065547 ). This study is part of the Rush Center for Urban Health Equity, which is funded by the National Institute for Heart Lung and Blood (NHLBI), grant number 1P50HL105189-01 .
See page 1143 for disclosure information.
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
