Safety and efficacy of aerobic training in patients with cancer who have heart failure: An analysis of the HF-ACTION randomized trial Journal Article

Authors: Jones, L. W.; Douglas, P. S.; Khouri, M. G.; Mackey, J. R.; Wojdyla, D.; Kraus, W. E.; Whellan, D. J.; O'Connor, C. M.
Article Title: Safety and efficacy of aerobic training in patients with cancer who have heart failure: An analysis of the HF-ACTION randomized trial
Abstract: Purpose: To investigate the efficacy and safety of aerobic training (AT) in patients with cancer with medically stable heart failure (HF). Patients and Methods: A retrospective analysis of 90 patients with cancer who have HF and who were randomly assigned to AT (n = 47) or guideline-based usual care (UC; n = 43) was performed. AT consisted of three supervised sessions per week at 20 to 45 minutes per session at 60% to 70% of heart rate reserve for 12 weeks followed by home-based sessions for 4 to 12 months. The primary end point was all-cause mortality and hospitalization. Secondary end points were other clinical events, safety, and change in exercise capacity ( VO2peak) and health-related quality of life (HRQOL). Results: Median follow-up was 35 months. In intention-to-treat (ITT) analyses, all-cause mortality or hospitalization at 2 years was 74% in the AT group compared with 67% in the UC group (adjusted hazard ratio [HR], 1.11; 95% CI, 0.69 to 1.77; P = .676). The incidence of cardiovascular mortality or cardiovascular hospitalization was significantly higher in the AT group compared with the UC group (41% v 67%; adjusted HR, 1.94; 95% CI, 1.12 to 3.16; P = .017). There were no differences in any VO 2peak or HRQOL end points. In post hoc analyses based on adherence to AT, all-cause mortality and hospitalization was 66% in adherent patients (≥ 90 minutes per week) compared with 84% in nonadherent patients (≤ 90 minutes per week). Conclusion: In ITT analyses, AT did not improve clinical outcomes in patients with cancer who had HF. Post hoc analyses suggested that patients not capable of adhering to the planned AT prescription may be at increased risk of clinical events. © 2014 by American Society of Clinical Oncology.
Keywords: controlled study; aged; major clinical study; treatment duration; cancer patient; follow up; quality of life; incidence; digoxin; retrospective study; patient care; heart failure; patient safety; therapy effect; heart arrhythmia; walking; heart left ventricle ejection fraction; cardiopulmonary exercise test; oxygen consumption; beta adrenergic receptor blocking agent; dipeptidyl carboxypeptidase inhibitor; aerobic exercise; randomized controlled trial (topic); loop diuretic agent; aldosterone; cardiovascular mortality; implantable cardioverter defibrillator; intention to treat analysis; human; male; female; priority journal; article; aerobic training; bicycle ergometry; biventricular assist device; lung gas exchange; program effectiveness
Journal Title: Journal of Clinical Oncology
Volume: 32
Issue: 23
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2014-08-10
Start Page: 2496
End Page: 2502
Language: English
DOI: 10.1200/jco.2013.53.5724
PROVIDER: scopus
PMCID: PMC4121507
PUBMED: 25002717
Notes: Export Date: 2 September 2014 -- CODEN: JCOND -- Source: Scopus
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MSK Authors
  1. Lee Winston Jones
    144 Jones