Background: Physical activity (PA) is inversely associated with adverse cardiovascular outcomes in healthy populations, but the impact of physical activity in patients with heart failure (HF) with preserved ejection fraction is less well characterized.

Methods: The baseline self-reported PA of 1751 subjects enrolled in the Americas region of the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) was categorized as poor, intermediate, or ideal PA with American Heart Association criteria. PA was related to the primary composite outcome (HF hospitalization, cardiovascular mortality, or aborted cardiac arrest), its components, and all-cause mortality with the use of multivariable Cox models.

Results: The mean age at enrollment was 68.6±9.6 years. Few patients met American Heart Association criteria for ideal activity (11% ideal, 14% intermediate, 75% poor). Over a median follow-up of 2.4 years, the primary composite outcome occurred in 519 patients (397 HF hospitalizations, 222 cardiovascular deaths, and 6 aborted cardiac arrests). Compared with those with ideal baseline PA, poor and intermediate baseline PA was associated with a greater risk of the primary outcome (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.28–3.28; HR, 1.95; 95% CI, 1.15–3.33, respectively), HF hospitalization (HR, 1.93; 95% CI, 1.16–3.22; HR, 1.84; 95% CI, 1.02–3.31), cardiovascular mortality (HR, 4.36; 95% CI, 1.37–13.83; HR, 4.05; 95% CI, 1.17–14.04), and all-cause mortality (HR, 2.95; 95% CI, 1.44–6.02; HR, 2.05; 95% CI, 0.90–4.67) after multivariable adjustment for potential confounders.

Conclusions: In patients with HF with preserved ejection fraction, both poor and intermediate self-reported PA were associated with higher risk of HF hospitalization and mortality.

Clinical Trial Registration: URL: https://clinicaltrials.gov. Unique identifier: NCT00094302.

背景：在健康人群中，体育锻炼（PA）与不良心血管事件成反比，但对于射血分数保留的心力衰竭（HF）患者，体育锻炼的影响尚不十分清楚。

方法：根据美国心脏协会的标准，将在TOPCAT试验的美洲地区（采用醛固酮拮抗剂治疗保留的心脏功能性心力衰竭）的1751名受试者的自我报告的基线PA分为不良，中度或理想PA。使用多变量Cox模型，PA与主要的综合结局（HF住院，心血管疾病死亡率或心脏骤停中止），其组成以及全因死亡率有关。

结果：入组的平均年龄为68.6±9.6岁。很少有患者达到美国心脏协会理想活动标准（11％理想，14％中级，75％贫困）。在2.4年的中位随访中，有519例患者发生了主要的复合结局（397例HF住院，222例心血管死亡和6例心脏骤停中止）。与具有理想基线PA的患者相比，基线PA差和中度与主要结局风险较高相关（危险比[HR]为2.05； 95％置信区间[CI]为1.28-3.28； HR为1.95； 95％ CI，分别为1.15-3.33），HF住院（HR，1.93； 95％CI，1.16-3.22； HR，1.84； 95％CI，1.02-3.31），心血管疾病死亡率（HR，4.36； 95％CI，1.37- 13.83； HR，4.05； 95％CI，1.17-14.04）和全因死亡率（HR，2.95； 95％CI，1.44-6.02； HR，2.05； 95％CI，0.90-4。

结论：在射血分数保留的心力衰竭患者中，自我报告的PA差和中度均与心衰住院和死亡的风险较高有关。

临床试验注册： URL：https : //clinicaltrials.gov。唯一标识符：NCT00094302。