Abstract
BACKGROUND: The aim of this study was to assess the impact of panvascular disease (PVD) on quality of life (QOL), exercise capacity, and clinical outcomes, in patients with heart failure (HF) with reduced ejection fraction (HFrEF). METHODS: We performed a post hoc analysis of the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION; NCT00047437). Patients with PVD were defined as those having coronary heart disease, stroke, or peripheral vascular disease at baseline. Multivariable Cox proportional hazard models were constructed to evaluate the effect of PVD on the primary endpoint (all-cause mortality or hospitalization) and secondary endpoints (all-cause mortality, cardiovascular (CV) mortality or CV hospitalization, and CV mortality or HF hospitalization). Generalized estimating-equation models were constructed to evaluate the effect of PVD on QOL (Kansas City Cardiomyopathy Questionnaire score) and exercise capacity (peak oxygen consumption and 6-minute walk test distance). RESULTS: Of 2119 patients with chronic HFrEF, 1202 (56.7%) had comorbid PVD. PVD was associated significantly with reduced exercise capacity (P < 0.001). Patients with PVD had a higher risk of all-cause mortality or hospitalization (hazard ratio [HR] 1.15, 95% confidence interval [CI]: 1.02-1.29), CV mortality or CV hospitalization (HR 1.22, 95% CI: 1.07-1.39), and CV mortality or HF hospitalization (HR 1.25, 95% CI: 1.05-1.48), compared with the risk for patients without PVD. Aerobic exercise training did not significantly improve the prognosis of HFrEF patients, in either the PVD or the non-PVD subgroups. CONCLUSIONS: PVD may adversely affect the QOL, exercise capacity, and prognosis of patients with chronic HFrEF.