HF-ACTION
Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training
Patient / Population Intervention / Exposure Comparison Outcome
In 2,331 patients with heart failure and reduced ejection fraction, a supervised aerobic exercise-training programme did not significantly reduce all-cause mortality or hospitalisation compared with usual care.
N
2,331patients
Design
Randomised controlled trial, median follow-up 30 months
Endpoint
All-cause mortality or all-cause hospitalisation
Relevance
2Important — one of several pillars.
Result65 % vs 68 % (HR 0.93; 95 % CI 0.84–1.02; p=0.13); prespecified adjusted HR 0.89 (95 % CI 0.81–0.99; p=0.03). No excess of adverse events.
O'Connor CM, Whellan DJ, Lee KL, et al. JAMA. 2009;301(14):1439-1450. 10.1001/jama.2009.454
Cited in guidelines
Discussion & critique
The unadjusted primary endpoint was neutral and adherence fell steadily, so it arguably tested exercise prescription rather than exercise itself. It is the only adequately powered outcome trial of training in heart failure, established its safety, and underpins the class-I recommendation for exercise training.