title: Relation of Angina Pectoris to Outcomes, Quality of Life, and Response to Exercise Training in Patients With Chronic Heart Failure (from HF-ACTION).
abstract: Angina pectoris (AP) is associated with worse outcomes in heart failure (HF). We investigated the association of AP with health-related quality of life (HRQoL), exercise capacity, and clinical outcomes and its interaction with exercise training in an HF population. We grouped 2,331 patients with HF with reduced ejection fraction in the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) trial of usual care ± exercise training according to whether they had self-reported AP by Canadian classification score. HRQoL and clinical outcomes were assessed by AP status. In HF-ACTION, 406 patients (17%) had AP at baseline (44% with Canadian classification score ≥II) with HF severity similar to those without AP. Patients with AP had similar baseline exercise capacity but worse depressive symptoms and HRQoL. AP was associated with 22% greater adjusted risk for all-cause mortality/hospitalizations, driven by hospitalizations. There was significant interaction between baseline AP and exercise training peak VO2change (p = 0.019) but not other end points. Exercise training was associated with greater peak VO2improvement after 3 months in patients with AP (treatment effect = 1.25 ml/kg/min, 95% CI 0.6 to 1.9). In conclusion, AP was associated with worse HRQoL and depressive symptoms. Despite greater peak VO2improvement with exercise training, patients with AP experienced more adverse outcomes.
authors: Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina. Electronic address: Kishan.parikh@dm.duke.edu.
authors: Kishan S
authors: KS
authors: Parikh
authors: Duke Clinical Research Institute, Durham, North Carolina.
authors: Adrian
authors: A
authors: Coles
authors: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Phillip J
authors: PJ
authors: Schulte
authors: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors: William E
authors: WE
authors: Kraus
authors: Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors: Jerome L
authors: JL
authors: Fleg
authors: Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Hospital, Detroit, Michigan.
authors: Steven J
authors: SJ
authors: Keteyian
authors: Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.
authors: Ileana L
authors: IL
authors: Piña
authors: Duke Clinical Research Institute, Durham, North Carolina.
authors: Mona
authors: M
authors: Fiuzat
authors: Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania.
authors: David J
authors: DJ
authors: Whellan
authors: Duke Clinical Research Institute, Durham, North Carolina; Inova Heart and Vascular Institute, Division of Cardiology, Department of Medicine, Falls Church, Virginia.
authors: Christopher M
authors: CM
authors: O'Connor
authors: Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors: Robert J
authors: RJ
authors: Mentz
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000150:complications*; D002423:Cause of Death; D002908:Chronic Disease; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000534:rehabilitation*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010101:Oxygen Consumption; D011379:Prognosis; D016016:Proportional Hazards Models; D011788:Quality of Life; D016896:Treatment Outcome