title: Race, exercise training, and outcomes in chronic heart failure: findings from Heart Failure - a Controlled Trial Investigating Outcomes in Exercise TraiNing (HF-ACTION).
abstract: BACKGROUND
  The strength of race as an independent predictor of long-term outcomes in a contemporary chronic heart failure (HF) population and its association with exercise training response have not been well established. We aimed to investigate the association between race and outcomes and to explore interactions with exercise training in patients with ambulatory HF.
  
  
  METHODS
  We performed an analysis of HF-ACTION, which randomized 2331 patients with HF having an ejection fraction ≤35% to usual care with or without exercise training. We examined characteristics and outcomes (mortality/hospitalization, mortality, and cardiovascular mortality/HF hospitalization) by race using adjusted Cox models and explored an interaction with exercise training.
  
  
  RESULTS
  There were 749 self-identified black patients (33%). Blacks were younger with significantly more hypertension and diabetes, less ischemic etiology, and lower socioeconomic status versus whites. Blacks had shorter 6-minute walk distance and lower peak VO2 at baseline. Over a median follow-up of 2.5 years, black race was associated with increased risk for all outcomes except mortality. After multivariable adjustment, black race was associated with increased mortality/hospitalization (hazard ratio [HR] 1.16, 95% CI 1.01-1.33) and cardiovascular mortality/HF hospitalization (HR 1.46, 95% CI 1.20-1.77). The hazard associated with black race was largely caused by increased HF hospitalization (HR 1.58, 95% CI 1.27-1.96), given similar cardiovascular mortality. There was no interaction between race and exercise training on outcomes (P > .5).
  
  
  CONCLUSIONS
  Black race in patients with chronic HF was associated with increased prevalence of modifiable risk factors, lower exercise performance, and increased HF hospitalization, but not increased mortality or a differential response to exercise training.
authors.affiliation: Duke University, Durham, NC. Electronic address: robert.mentz@duke.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Schulte
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Fleg
authors.forename: Ileana L
authors.initials: IL
authors.lastname: Piña
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Keteyian
authors.forename: Gordon
authors.initials: G
authors.lastname: Moe
authors.forename: Anil
authors.initials: A
authors.lastname: Nigam
authors.forename: Ann M
authors.initials: AM
authors.lastname: Swank
authors.forename: Anekwe E
authors.initials: AE
authors.lastname: Onwuanyi
authors.forename: Meredith
authors.initials: M
authors.lastname: Fitz-Gerald
authors.forename: Andrew
authors.initials: A
authors.lastname: Kao
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Ellis
authors.forename: William E
authors.initials: WE
authors.lastname: Kraus
authors.forename: David J
authors.initials: DJ
authors.lastname: Whellan
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015444:Exercise / Q000502:physiology*; D005260:Female; D006333:Heart Failure / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D044469:Racial Groups; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
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