Transplant Cardiologists Study Exercise and Heart Failure

Strong Memorial only upstate hospital participating in $37 million national trial

March 01, 2005

Transplant cardiologists with the Strong Health Program in Heart Failure and Transplantation are part of a National Heart Lung Blood Institute study that will consider whether patients living with heart failure may improve their health and extend their life by exercising.

The $37 million heart failure trial, called HF-ACTION, will be conducted at more than 50 medical centers in the United States, Canada and Europe. Strong Memorial Hospital is the only upstate New York site to participate.

Strong’s participation is being led by Leway Chen, M.D., M.P.H., senior transplant cardiologist and medical director of the Strong Health Program in Heart Failure and Transplantation, and Thomas Rocco, M.D., chief of Cardiology at Highland Hospital. William Hall, M.D., director of the Center for Healthy Aging, will assist with the study.

The five-year study, coordinated by Duke University Medical Center, will consider 3,000 patients living with heart failure. It is the first large-scale trial designed to determine whether exercise can reduce mortality for patients with heart failure, and also whether it can reduce hospital admissions.

Smaller studies have shown exercise has a positive effect on heart failure patients’ health, including improving daily physical activity, and reducing depression and harmful hormone levels. Yet no study before HF-ACTION has considered the effect exercise may have on mortality.

Heart failure is a condition marked by the inability of the heart muscle to pump enough blood through the body. Also known as congestive heart failure, its causes include infections of the heart, coronary artery disease, high blood pressure, diabetes, and heart attack and valve problems.

An estimated 4.8 million Americans suffer from the condition, with 550,000 new cases reported each year. Once diagnosed with heart failure, about 50 percent of patients die within five years.

Heart failure can leave patients exhausted and short of breath, sometimes with a persistent cough, and normal activities may be severely restricted. Fluid accumulation, or edema, may cause swelling of the feet, ankles and legs, and fluid also may build up in the lungs. Although there is no cure, a variety of drugs often are used to improve the strength of the heartbeat, to relax blood vessels or to remove buildup of fluid in the lungs.

Criteria for participation in the HF-ACTION trial is broad, unlike previous heart failure studies that were selective in the types of patients enrolled. Nearly every patient with a weak heart is a candidate for HF-ACTION.

All participants undergo medical examinations and provide a detailed medical history. They are then randomized to traditional care, or traditional care with exercise training. Patients in the exercise group are provided a personal exercise program tailored to each individual’s medical condition and physical abilities. For the first three months, patients in this group exercise three times per week under medical supervision, using a treadmill or a stationary bicycle. Beyond three months, patients continue their exercise regimen at home for three years. Funding for the study provides for exercise equipment patients use at home.

Throughout the trial, researchers maintain frequent telephone contact with patients in an effort to monitor their health and ensure continuation of the exercise plan. Results from the exercise group will be compared to the control group whose members receive the latest standard of care for heart failure, without a structured exercise program.

In addition to tracking mortality and hospitalization rates of study participants, researchers also hope to learn more about medical complications caused by exercise, and to ascertain what types of patients may benefit from exercise. Genetic, economic and quality-of-life analyses also will be done to determine their effect on mortality rates.

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Karin Christensen
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