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Relationship of age and exercise performance in patients with heart failure: the HF-ACTION study.

Publication ,  Journal Article
Forman, DE; Clare, R; Kitzman, DW; Ellis, SJ; Fleg, JL; Chiara, T; Fletcher, G; Kraus, WE; HF-ACTION Investigators,
Published in: Am Heart J
October 2009

BACKGROUND: More than three fourths of patients with heart failure (HF) are 65 years and older, and older age is associated with worse symptoms and prognoses than is younger age. Reduced exercise capacity is a chief HF complaint and indicates poorer prognosis, especially among elderly persons, but the mechanisms underlying functional decline in older patients with HF are largely unknown. METHODS: Baseline cardiopulmonary exercise testing data from the HF-ACTION trial were assessed to clarify age effects on peak oxygen consumption (VO(2)) and ventilation-carbon dioxide production (VE/VCO(2)) slope. RESULTS: Among 2,331 New York Heart Association class II-IV patients with HF, increased age corresponded to decreased peak VO(2) (-0.14 mL kg(-1) min(-1) per year >40 years; P < .0001) and increased VE/VCO(2) slope (0.30 U/y >70 years; P < .0001). In a multivariable model with 34 other potential determinants, age was the strongest independent predictor of peak VO(2) (partial R(2) 0.130, total R(2) 0.392; P < .001) and a significant but relatively weaker predictor of VE/VCO(2) slope (partial R(2) 0.037, total R(2) 0.199; P < .001). Blunted peak heart rate was also a strong predictor of peak VO(2). Although peak heart rate and age were strongly correlated, both were significant independent predictors of peak VO(2) when analyzed simultaneously in a model. Aggregate comorbidity increased significantly with age but did not account for age effects on peak VO(2). CONCLUSIONS: Age is the strongest predictor of peak VO(2) and a significant predictor of VE/VCO(2) slope in the HF-ACTION population. Age-dependent comorbidities do not explain changes in peak VO(2). Age-related changes in cardiovascular physiology, potentially magnified by the HF disease state, should be considered a contributor to the pathophysiology and a target for more effective therapy in older patients with HF.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

October 2009

Volume

158

Issue

4 Suppl

Start / End Page

S6 / S15

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Randomized Controlled Trials as Topic
  • Pulmonary Ventilation
  • Prognosis
  • Oxygen Consumption
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Forman, D. E., Clare, R., Kitzman, D. W., Ellis, S. J., Fleg, J. L., Chiara, T., … HF-ACTION Investigators, . (2009). Relationship of age and exercise performance in patients with heart failure: the HF-ACTION study. Am Heart J, 158(4 Suppl), S6–S15. https://doi.org/10.1016/j.ahj.2009.07.018
Forman, Daniel E., Robert Clare, Dalane W. Kitzman, Stephen J. Ellis, Jerome L. Fleg, Toni Chiara, Gerald Fletcher, William E. Kraus, and William E. HF-ACTION Investigators. “Relationship of age and exercise performance in patients with heart failure: the HF-ACTION study.Am Heart J 158, no. 4 Suppl (October 2009): S6–15. https://doi.org/10.1016/j.ahj.2009.07.018.
Forman DE, Clare R, Kitzman DW, Ellis SJ, Fleg JL, Chiara T, et al. Relationship of age and exercise performance in patients with heart failure: the HF-ACTION study. Am Heart J. 2009 Oct;158(4 Suppl):S6–15.
Forman, Daniel E., et al. “Relationship of age and exercise performance in patients with heart failure: the HF-ACTION study.Am Heart J, vol. 158, no. 4 Suppl, Oct. 2009, pp. S6–15. Pubmed, doi:10.1016/j.ahj.2009.07.018.
Forman DE, Clare R, Kitzman DW, Ellis SJ, Fleg JL, Chiara T, Fletcher G, Kraus WE, HF-ACTION Investigators. Relationship of age and exercise performance in patients with heart failure: the HF-ACTION study. Am Heart J. 2009 Oct;158(4 Suppl):S6–S15.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

October 2009

Volume

158

Issue

4 Suppl

Start / End Page

S6 / S15

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Randomized Controlled Trials as Topic
  • Pulmonary Ventilation
  • Prognosis
  • Oxygen Consumption
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
  • Female