Physical activity and prognosis in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist)

Sheila M. Hegde, Brian Claggett, Amil M. Shah, Eldrin F. Lewis, Inder Anand, Sanjiv J. Shah, Nancy K. Sweitzer, James C. Fang, Bertram Pitt, Marc A. Pfeffer, Scott D. Solomon

Research output: Contribution to journalArticle

37 Scopus citations

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 allcause 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.

Original languageEnglish (US)
Pages (from-to)982-992
Number of pages11
JournalCirculation
Volume136
Issue number11
DOIs
StatePublished - Sep 1 2017

Keywords

  • Clinical trial [publication type]
  • Exercise
  • Heart failure
  • Hospitalization
  • Spironolactone
  • Treatment outcome

PubMed: MeSH publication types

  • Journal Article
  • Multicenter Study
  • Randomized Controlled Trial

Fingerprint Dive into the research topics of 'Physical activity and prognosis in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist)'. Together they form a unique fingerprint.

  • Cite this

    Hegde, S. M., Claggett, B., Shah, A. M., Lewis, E. F., Anand, I., Shah, S. J., Sweitzer, N. K., Fang, J. C., Pitt, B., Pfeffer, M. A., & Solomon, S. D. (2017). Physical activity and prognosis in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist). Circulation, 136(11), 982-992. https://doi.org/10.1161/CIRCULATIONAHA.117.028002