Heart failure: exercise training reduced death and hospital readmission for heart failure in stable patients

Clinical bottom line (level 1b)

  1. Patients with stable heart failure who performed exercise training compared with doing nothing were less likely to die (NNT = 4 at 3.3 years) or be readmitted to hospital with heart failure (NNT = 5 at 3.3 years) .
Belardinelli et al: Circulation 1999; 99: 1173-1182
Expires November 2003

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: 2 university hospitals, USA and Italy

99 patients (aged mean 59, 89% male) chronic heart failure in a stable condition for at least 3 months

Excluded if
  • significant chronic pulmonary illness
  • uncontrolled hypertension
  • renal insufficiency (serum creatinine 2.5 mg/dl or more)
  • orthopaedic or neurological limitations
  • unstable angina, recent acute myocardial infarction
  • decompensated congestive heart failure
  • haemodynamically significant valvular heart disease


    • Control Group: (n = 49, 49 analysed): no exercise training
    Experimental Group: (n = 50, 50 analysed): exercise training for 14 months (stretching exercise followed by 40 minutes of exercise cycling twice a week)

    100% followed for 3.3 years

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    death 3.3 years 20
    (40.8%)    		 9
    (18.0%)    		 56%
    (13% to 78%)    		 22.8%
    (5.42% to 40.2%)    		 4
    (2 to 18)
    hospital readmission for heart failure 3.3 years 14
    (28.6%)    		 5
    (10.0%)    		 65%
    (10% to 86%)    		 18.6%
    (3.43% to 33.7%)    		 5
    (3 to 29)

    Comments

    1. The study evaluated a number of endpoints without any being clearly classified as more important than others - This potential weakness is removed by the improvement demonstrated in all measures.
    2. Patients who performed exercise training had a greater quality of life (on Minnesota Living with Heart Failure Questionnaire - mean difference 54: 95% CI: 32 to 76)

    Citation

    1. Belardinelli R, Georgiou D, Cianci G, et al: Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome. Circulation 1999; 99: 1173-1182
    Search Terms: from 'other articles noted' in ACP Journal Club
    Contributor: Chris Ball and Clare Wotton, November 1999
    Reviewer: Christian Torp-Pedersen

    Clinical Question.
    Patient chronic stable heart failure
    Intervention or Exposure exercise training
    Outcome death, admission to hospital with heart failure, quality of life