College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska.
College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska.
J Card Fail. 2022 Mar;28(3):431-442. doi: 10.1016/j.cardfail.2021.09.003. Epub 2021 Sep 15.
Despite exercise being one of few strategies to improve outcomes for individuals with heart failure with preserved ejection fraction (HFpEF), exercise clinical trials in HFpEF are plagued by poor interventional adherence. Over the last 2 decades, our research team has developed, tested, and refined Heart failure Exercise And Resistance Training (HEART) Camp, a multicomponent behavioral intervention to promote adherence to exercise in HF. We evaluated the effects of this intervention designed to promote adherence to exercise in HF focusing on subgroups of participants with HFpEF and heart failure with reduced ejection fraction (HFrEF).
This randomized controlled trial included 204 adults with stable, chronic HF. Of those enrolled, 59 had HFpEF and 145 had HFrEF. We tested adherence to exercise (defined as ≥120 minutes of moderate-intensity [40%-80% of heart rate reserve] exercise per week validated with a heart rate monitor) at 6, 12, and 18 months. We also tested intervention effects on symptoms (Patient-Reported Outcomes Measurement Information System-29 and dyspnea-fatigue index), HF-related health status (Kansas City Cardiomyopathy Questionnaire), and physical function (6-minute walk test). Participants with HFpEF (n = 59) were a mean of 64.6 ± 9.3 years old, 54% male, and 46% non-White with a mean ejection fraction of 55 ± 6%. Participants with HFpEF in the HEART Camp intervention group had significantly greater adherence compared with enhanced usual care at both 12 (43% vs 14%, phi = 0.32, medium effect) and 18 months (56% vs 0%, phi = 0.67, large effect). HEART Camp significantly improved walking distance on the 6-minute walk test (η = 0.13, large effect) and the Kansas City Cardiomyopathy Questionnaire overall (η = 0.09, medium effect), clinical summary (η = 0.16, large effect), and total symptom (η = 0.14, large effect) scores. In the HFrEF subgroup, only patient-reported anxiety improved significantly in the intervention group.
A multicomponent, behavioral intervention is associated with improvements in long-term adherence to exercise, physical function, and patient-reported outcomes in adults with HFpEF and anxiety in HFrEF. Our results provide a strong rationale for a large HFpEF clinical trial to validate these findings and examine interventional mechanisms and delivery modes that may further promote adherence and improve clinical outcomes in this population.
URL: https://clinicaltrials.gov/. Unique identifier: NCT01658670.
尽管运动是改善射血分数保留型心力衰竭（HFpEF）患者预后的少数策略之一，但 HFpEF 的运动临床试验却因干预措施的依从性差而受到困扰。在过去的 20 年中，我们的研究团队开发、测试和完善了心力衰竭运动和阻力训练（HEART）营，这是一种多成分的行为干预措施，旨在促进 HF 患者对运动的依从性。我们评估了这种干预措施对依从性的影响，该干预措施旨在促进 HFpEF 和射血分数降低型心力衰竭（HFrEF）患者对运动的依从性。
这项随机对照试验纳入了 204 名稳定的慢性 HF 成人患者。其中 59 名患者患有 HFpEF，145 名患者患有 HFrEF。我们在 6、12 和 18 个月时检测了运动的依从性（定义为每周至少进行 120 分钟中等强度[40%-80%心率储备]运动，并通过心率监测器进行验证）。我们还检测了干预措施对症状（患者报告的结局测量信息系统-29 和呼吸困难-疲劳指数）、HF 相关健康状况（堪萨斯城心肌病问卷）和身体功能（6 分钟步行测试）的影响。HFpEF 组（n=59）的平均年龄为 64.6±9.3 岁，54%为男性，46%为非白人，平均射血分数为 55±6%。HEART 营干预组的 HFpEF 患者与强化常规护理组相比，12 个月（43%比 14%，φ=0.32，中等效应）和 18 个月（56%比 0%，φ=0.67，大效应）时的依从性显著更高。HEART 营显著提高了 6 分钟步行测试的步行距离（η=0.13，大效应）和堪萨斯城心肌病问卷的整体评分（η=0.09，中等效应）、临床总结评分（η=0.16，大效应）和总症状评分（η=0.14，大效应）。在 HFrEF 亚组中，只有干预组患者的焦虑报告显著改善。
多成分行为干预与 HFpEF 患者运动依从性、身体功能和患者报告结局的长期改善以及 HFrEF 患者的焦虑改善相关。我们的研究结果为 HFpEF 的大型临床试验提供了强有力的理论依据，以验证这些发现，并研究可能进一步促进该人群依从性和改善临床结局的干预机制和实施模式。
