Physical Activity and Prognosis in the TOPCAT Trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist)

Abstract

Background: Physical activity (PA) is inversely associated with adverse cardiovascular outcomes in healthy populations, but the impact of physical activity in patients with heart failure (HF) with preserved ejection fraction is less well characterized.

Methods: The baseline self-reported PA of 1751 subjects enrolled in the Americas region of the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) was categorized as poor, intermediate, or ideal PA with American Heart Association criteria. PA was related to the primary composite outcome (HF hospitalization, cardiovascular mortality, or aborted cardiac arrest), its components, and all-cause mortality with the use of multivariable Cox models.

Results: The mean age at enrollment was 68.6±9.6 years. Few patients met American Heart Association criteria for ideal activity (11% ideal, 14% intermediate, 75% poor). Over a median follow-up of 2.4 years, the primary composite outcome occurred in 519 patients (397 HF hospitalizations, 222 cardiovascular deaths, and 6 aborted cardiac arrests). Compared with those with ideal baseline PA, poor and intermediate baseline PA was associated with a greater risk of the primary outcome (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.28-3.28; HR, 1.95; 95% CI, 1.15-3.33, respectively), HF hospitalization (HR, 1.93; 95% CI, 1.16-3.22; HR, 1.84; 95% CI, 1.02-3.31), cardiovascular mortality (HR, 4.36; 95% CI, 1.37-13.83; HR, 4.05; 95% CI, 1.17-14.04), and all-cause mortality (HR, 2.95; 95% CI, 1.44-6.02; HR, 2.05; 95% CI, 0.90-4.67) after multivariable adjustment for potential confounders.

Conclusions: In patients with HF with preserved ejection fraction, both poor and intermediate self-reported PA were associated with higher risk of HF hospitalization and mortality.

Clinical trial registration: URL: https://ichgcp.net/clinical-trials-registry/NCT00094302" title="See in ClinicalTrials.gov">NCT00094302.

Keywords: clinical trial [publication type]; exercise; heart failure; hospitalization; spironolactone; treatment outcome.

© 2017 American Heart Association, Inc.

Figures

Figure 1.. Baseline distribution of NYHA class and physical activity category.

Proportion of participants in each NYHA class by physical activity category as defined by AHA criteria (poor, intermediate, or ideal), p>0.001 for global comparison. NYHA-New York Heart Association, AHA-American Heart Association.

Figure 2.. Kaplan-Meier plots of time to primary outcome and two major components by physical activity category.

A, Time to primary outcome (HF hospitalization, CV death, or aborted cardiac arrest); B, time to first confirmed HF hospitalization; and C, time to CV death. HF-heart failure, CV-cardiovascular.

Figure 3.. Incidence rates of the primary outcome by amount of total physical activity.

Incidence rates of the primary outcome by decile of total physical activity (MET-min/week) through 2 years post-randomization. Total physical activity includes the amount of light activity in addition to AHA-recommended moderate and vigorous activity reported. Bars represent 95% confidence intervals. AHA-American Heart Association, D-decile.