Related Experiment Video
Updated: Jul 25, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Distinct Impact of Noncardiac Comorbidities on Exercise Capacity and Functional Status in Chronic Heart Failure
Pieter Martens1, Silvio N Augusto2, J Emanuel Finet1
1Kaufman Center for Heart Failure Treatment and Recovery, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Insights
Noncardiac comorbidities (NCCs) significantly impact heart failure (HF) patients. Managing diverse NCCs is crucial for improving exercise capacity and patient outcomes in chronic HF.
Area of Science:
- Cardiology
- Exercise Physiology
- Gerontology
Background:
- Noncardiac comorbidities (NCCs) are prevalent in heart failure (HF) patients.
- The combined impact of NCCs on exercise capacity and functional status in HF remains understudied.
Purpose of the Study:
- To investigate the cumulative effects of NCCs on exercise capacity and functional status in chronic heart failure (HF).
- To determine the association between NCC burden, HF type, and clinical outcomes.
Main Methods:
- Assessed baseline NCC status in multiple HF clinical trials (HF-ACTION, IRONOUT-HF, NEAT-HFpEF, INDIE-HFpEF, RELAX-HFpEF).
- Evaluated relationships with peak oxygen uptake (Vo2), 6-minute walk test (6MWT), Kansas City Cardiomyopathy Questionnaire (KCCQ), and all-cause mortality.
- Utilized cluster analysis to group patients based on distinct NCC profiles.
Main Results:
- A total of 2,777 patients were analyzed, revealing a higher NCC burden in HF with preserved ejection fraction.
- Obesity significantly limited peak Vo2 and 6MWT in HF with preserved ejection fraction.
- Increasing NCC burden correlated with decreased peak Vo2, 6MWT, and KCCQ scores.
- Cluster analysis identified three distinct NCC groups, with obesity and diabetes (cluster 3) showing the worst functional status and exercise response.
- Cluster 2 (chronic kidney disease, peripheral vascular disease) exhibited a higher risk of all-cause death compared to cluster 1 (stroke, cancer).
Conclusions:
- NCC type and burden cumulatively and significantly affect exercise capacity in chronic HF patients.
- Identified distinct clusters of NCCs associated with specific clinical outcomes.
- Findings highlight the importance of addressing multifaceted NCCs for optimizing HF management and patient prognosis.
Background:
Noncardiac comorbidities (NCCs) are common in patients with heart failure (HF), but how they jointly affect exercise capacity and functional status is relatively unexplored.
Objectives:
This study sought to investigate the cumulative effects of NCC on exercise capacity and functional status in chronic HF.
Methods:
Baseline NCC-status was assessed in HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), IRONOUT-HF (Oral Iron Repletion Effects on Oxygen Uptake in Heart Failure), NEAT-HFpEF (Nitrate's Effect on Activity Tolerance in Heart Failure With Preserved Ejection Fraction), INDIE-HFpEF (Inorganic Nitrite Delivery to Improve Exercise Capacity in HFpEF), and RELAX-HFpEF (Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure with Preserved Ejection Fraction) trials, and relations with peak Vo2 and 6-minute walk test (6MWT), Kansas City Cardiomyopathy Questionnaire (KCCQ), and all-cause death were determined according to HF type (with reduced vs preserved ejection fraction). Cluster analysis of the different NCCs was performed.
Results:
A total of 2,777 patients were evaluated (mean age: 60 ± 13 years; median NCC burden in HF with preserved vs reduced ejection fraction: 3 [IQR: 2-4] vs 2 [IQR: 1-3]; P < 0.001). Obesity played a more important role in HF with preserved ejection fraction in limiting peak Vo2 and 6MWT. There was a progressive decline in peak Vo2, 6MWT, and KCCQ with increasing NCC burden. Cluster analysis revealed 3 NCC clusters: cluster 1: predominance of stroke and cancer; cluster 2: predominance of chronic kidney disease and peripheral vascular disease; and cluster 3: predominance of obesity and diabetes. Patients in cluster 3 had the worst peak Vo2, 6MWT, and KCCQ despite having the lowest N-terminal pro-B-type natriuretic peptide and exhibited diminished response to aerobic exercise training (peak Vo2Pinteraction = 0.045); however, it had similar risk for all-cause death as cluster 1, whereas cluster 2 had higher risk of death than cluster 1 (HR: 1.60 [95% CI: 1.25-2.04]; P < 0.001).
Conclusions:
NCC type and burden have a significant and cumulative effect on exercise capacity, occur in clusters, and are associated with clinical outcomes in patients with chronic HF.
More Related Videos
Related Concept Videos
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:17Pathophysiology of Heart Failure
01:27Heart Failure I: Introduction
01:20Exercise and Cardiovascular Response
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...
01:30Heart Failure IV: Classification and Diagnostic Evaluation
01:26Heart Failure III: Clinical Manifestations