title: Exercise Training in Patients With Chronic Heart Failure and Atrial Fibrillation.
abstract: BACKGROUND
  The safety and efficacy of aerobic exercise in heart failure (HF) patients with atrial fibrillation (AF) has not been well evaluated.
  
  
  OBJECTIVE
  This study examined whether outcomes with exercise training in HF vary according to AF status.
  
  
  METHODS
  HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) randomized 2,331 ambulatory HF patients with ejection fraction ≤35% to exercise training or usual care. We examined clinical characteristics and outcomes (mortality/hospitalization) by baseline AF status (past history of AF or AF on baseline electrocardiogram vs. no AF) using adjusted Cox models and explored an interaction with exercise training. We assessed post-randomization AF events diagnosed via hospitalizations for AF and reports of serious arrhythmia caused by AF.
  
  
  RESULTS
  Of 2,292 patients with baseline rhythm data, 382 (17%) had AF, 1,602 (70%) had sinus rhythm, and 308 (13%) had "other" rhythm. Patients with AF were older and had lower peak Vo2. Over a median follow-up of 2.6 years, AF was associated with a 24% per year higher rate of mortality/hospitalization (hazard ratio [HR]: 1.53; 95% confidence interval [CI]: 1.34 to 1.74; p < 0.001) in unadjusted analysis; this did not remain significant after adjustment (HR: 1.15; 95% CI: 0.98 to 1.35; p = 0.09). There was no significant difference in AF event rates by randomized treatment assignment in the overall population or by baseline AF status (all p > 0.10). There was no interaction between AF and exercise training on measures of functional status or clinical outcomes (all p > 0.10).
  
  
  CONCLUSIONS
  AF in patients with chronic HF was associated with older age, reduced exercise capacity at baseline, and a higher overall rate of clinical events, but not a differential response to exercise training for clinical outcomes or changes in exercise capacity. (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF-ACTION]; NCT00047437).
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina. Electronic address: nancy.luo@duke.edu.
authors.forename: Nancy
authors.initials: N
authors.lastname: Luo
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Peter
authors.initials: P
authors.lastname: Merrill
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Kishan S
authors.initials: KS
authors.lastname: Parikh
authors.affiliation: Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Whellan
authors.affiliation: Montefiore-Einstein Medical Center, New York, New York.
authors.forename: Ileana L
authors.initials: IL
authors.lastname: Piña
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Mona
authors.initials: M
authors.lastname: Fiuzat
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: William E
authors.initials: WE
authors.lastname: Kraus
authors.affiliation: Wake Forest School of Medicine, Winston Salem, North Carolina.
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
authors.affiliation: Henry Ford Hospital, Detroit, Michigan.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Keteyian
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Inova Heart and Vascular Institute, Falls Church, Virginia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology*; D015444:Exercise / Q000502:physiology*; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology
keywords: arrhythmia; cardiopulmonary reserve; exercise training; fitness