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Absence of Fitness Improvement Is Associated with Outcomes in Heart Failure Patients.

Bakker, EA and Snoek, JA and Meindersma, EP and Hopman, MTE and Bellersen, L and Verbeek, ALM and Thijssen, DHJ and Eijsvogels, TMH (2017) Absence of Fitness Improvement Is Associated with Outcomes in Heart Failure Patients. Medicine and Science in Sports and Exercise. ISSN 1530-0315

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Abstract

PURPOSE: To examine the clinical impact of cardiorespiratory fitness (CRF) and improvements in CRF after cardiac rehabilitation (CR) in heart failure (HF) patients for their risk of all-cause mortality and unplanned hospitalization. Secondly, to investigate possible factors associated with the absence of improvement in CRF after rehabilitation. METHODS: We included 155 HF patients receiving CR between October 2009 and January 2015. Patients performed an incremental bicycle test to assess CRF through peak oxygen uptake (VO2-peak) before and after CR-based supervised exercise training. Patients were classified as responders or non-responders based on pre-to-post CR changes in VO2-peak (≥6% and <6%, respectively). Cox proportional hazards models evaluated all-cause mortality and unplanned hospitalization during 5 years of follow-up. Patient characteristics, HF features and co-morbidities were used to predict changes in VO2-peak using logistic regression analysis. RESULTS: Seventy HF patients (45%) were classified as responder. Non-responders had a significantly higher risk of all-cause mortality or hospitalization (HR = 2.15, 95% CI = 1.17-3.94) compared to responders. This was even higher in non-responders with low CRF at baseline (HR = 4.88, 95% CI = 1.71-13.93). Factors associated with non-response to CR were age (OR = 1.07/year, 95% CI = 1.03-1.11), baseline VO2-peak (OR = 1.16/ml/min/kg, 95% CI = 1.06-1.26) and adherence to CR (OR = 0.98/percentage, 95% CI = 0.96-0.998). CONCLUSION: Independent from baseline CRF, the inability to improve VO2-peak by CR doubled the risk of death or unplanned hospitalization. The combination of lower baseline CRF and non-response was associated with even poorer clinical outcomes. Especially older HF patients with higher baseline VO2-peak and lower adherence have a higher probability of becoming a non-responder.

Item Type: Article
Additional Information: This is the accepted version of an article which has been published in final form at http://dx.doi.org/10.1249/MSS.0000000000001429
Uncontrolled Keywords: 1106 Human Movement And Sports Science
Subjects: R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions: Sport & Exercise Sciences
Publisher: American College of Sports Medicine
Related URLs:
Date Deposited: 02 Oct 2017 08:07
Last Modified: 02 Oct 2017 08:07
DOI or Identification number: 10.1249/MSS.0000000000001429
URI: http://researchonline.ljmu.ac.uk/id/eprint/7245

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