Research article summary (published 29 Sep 2009):

Baseline differences in the HF-ACTION trial by sex.

Full Abstract

BACKGROUND: In patients with heart failure (HF), assessment of functional capacity plays an important prognostic role. Both 6-minute walk and cardiopulmonary exercise testing have been used to determine physical function and to determine prognosis and even listing for transplantation. However, as in HF trials, the number of women reported has been small, and the cutoffs for transplantation have been representative of male populations and extrapolated to women. It is also well known that peak VO(2) as a determinant of fitness is inherently lower in women than in men and potentially much lower in the presence of HF. Values for a female population from which to draw for this important determination are lacking. METHODS: The HF-ACTION trial randomized 2,331 patients (28% women) with New York Heart Association class II-IV HF due to systolic dysfunction to either a formal exercise program in addition to optimal medical therapy or to optimal medical therapy alone without any formal exercise training. To characterize differences between men and women in the interpretation of final cardiopulmonary exercise testing models, the interaction of individual covariates with sex was investigated in the models of (1) VE/VCO(2), (2) VO(2) at ventilatory threshold (VT), (3) distance on the 6-minute walk, and (4) peak VO(2). RESULTS: The women were younger than the men and more likely to have a nonischemic etiology and a higher ejection fraction. Dose of angiotensin converting enzyme inhibitor (ACEI) was lower in the women, on average. The lower ACEI dose may reflect the higher use of angiotensin II receptor blocker (ARB) in women. Both the peak VO(2) and the 6-minute walk distance were significantly lower in the women than in the men. Perhaps the most significant finding in this dataset of baseline characteristics is that the peak VO(2) for women was significantly lower than that for men with similar ventricular function and health status. CONCLUSION: Therefore, in a well-medicated, stable, class II-IV HF cohort of patients who are able to exercise, women have statistically significantly lower peak VO(2) and 6-minute walk distance than men with similar health status and ventricular function. These data should prompt careful thought when considering prognostic markers for women and listing for cardiac transplant.

Author information

Author/s: Piña, Ileana L (IL); Kokkinos, Peter (P); Kao, Andrew (A); Bittner, Vera (V); Saval, Matt (M); Clare, Bob (B); Goldberg, Lee (L); Johnson, Maryl (M); Swank, Ann (A); Ventura, Hector (H); Moe, Gordon (G); Fitz-Gerald, Meredith (M); Ellis, Stephen J (SJ); Vest, Marianne (M); Cooper, Lawton (L); Whellan, David (D); HF-ACTION Investigators;

Affiliation: Case Western Reserve University, Cleveland VA Medical Center, Education Department, Wade Park, Cleveland, OH 44106, USA.

Grants: 5U01HL063747 (Agency:NHLBI NIH HHS) ; 5U01HL064250 (Agency:NHLBI NIH HHS) ; 5U01HL064257 (Agency:NHLBI NIH HHS) ; 5U01HL064264 (Agency:NHLBI NIH HHS) ; 5U01HL064265 (Agency:NHLBI NIH HHS) ; 5U01HL066461 (Agency:NHLBI NIH HHS) ; 5U01HL066482 (Agency:NHLBI NIH HHS) ; 5U01HL066491 (Agency:NHLBI NIH HHS) ; 5U01HL066494 (Agency:NHLBI NIH HHS) ; 5U01HL066497 (Agency:NHLBI NIH HHS) ; 5U01HL066501 (Agency:NHLBI NIH HHS) ; 5U01HL068973 (Agency:NHLBI NIH HHS) ; 5U01HL068980 (Agency:NHLBI NIH HHS) ; P60AG10484 (Agency:NIA NIH HHS) ; R37AG18915 (Agency:NIA NIH HHS)

Journal and publication information

Publication Type: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural

Journal: American heart journal (Am Heart J), published in United States. (Language: eng)

Reference: 2009-Oct; vol 158 (issue 4 Suppl) : pp S16-23

Dates: Created 2009/09/28; Completed 2009/10/29;

PMID: 19782784, status: MEDLINE (last retrieval date: 10/29/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged Angiotensin-Converting Enzyme Inhibitors - therapeutic use Data Collection - statistics & numerical data Exercise Test - statistics & numerical data Exercise Therapy Exercise Tolerance Female Heart Failure - diagnosis; drug therapy; physiopathology Heart Transplantation - standards

Heart Transplantation - standards Humans Male Multicenter Studies as Topic Oxygen Consumption - physiology Prognosis Sex Distribution Stroke Volume - physiology Ventricular Dysfunction, Left - physiopathology

Associated Chemicals: Angiotensin-Converting Enzyme Inhibitors (0)

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