The primary aim of the ACTION Trial is to determine the long-term safety and effectiveness of exercise training for New York Heart Association Classes II-IV congestive heart failure patients in addition to standard of care versus a strategy of standard care alone. The secondary objective is to determine the incidence and significance of exercise-related complications, the effect on exercise tolerance and quality of life, and the cost-effectiveness of training. The exercise training will include 36 facility-based training sessions followed by home-based exercise and interval facility sessions. Training will be at 60-70% of heart rate reserve. Patients randomized to the training arm will train by either walking or bicycle ergometers. Treadmills or exercise bicycles will be provided to training patients by the coordinating center, if desired. Effectiveness will be defined as the primary combined endpoint of all-cause mortality and all-cause hospitalizations. The expected annual baseline rate is 30% for the control group. The expected non-adherence and drop-out rate is 35% the first year and 15% annually thereafter, with a cross-over rate of 5% per year. The regional center team and the coordinating center will implement multiple strategies to improve adherence in patients in the training arm. Using these assumptions, a total sample size of 3000 subjects will be required to detect a 20% reduction in the primary outcome with an alpha level of 0.05 and a power greater than 80%. If the non-adherence and drop-out rate decrease to 30% in the first year and 12.5% annually thereafter, the power to detect a 20% difference is greater than 90%. The primary analysis will be based on intent-to-treat. The trial will take place over 5 years with an initial 6 months for planning, training, and implementation; 3 years of enrollment; 1 year of follow-up; and 6 months for close out, analysis, and presentation.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01HL066461-05
Application #
7112951
Study Section
Special Emphasis Panel (ZHL1-CSR-A (O1))
Program Officer
Cooper, Lawton S
Project Start
2002-09-30
Project End
2008-06-30
Budget Start
2006-08-01
Budget End
2007-06-30
Support Year
5
Fiscal Year
2006
Total Cost
$340,000
Indirect Cost
Name
Duke University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
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Li, Yanhong; Levy, Wayne C; Neilson, Matthew P et al. (2014) Associations between seattle heart failure model scores and medical resource use and costs: findings from HF-ACTION. J Card Fail 20:541-7
Jones, Lee W; Douglas, Pamela S; Khouri, Michel G et al. (2014) Safety and efficacy of aerobic training in patients with cancer who have heart failure: an analysis of the HF-ACTION randomized trial. J Clin Oncol 32:2496-502
Li, Yanhong; Neilson, Matthew P; Whellan, David J et al. (2013) Associations between Seattle Heart Failure Model scores and health utilities: findings from HF-ACTION. J Card Fail 19:311-6
Blumenthal, James A; Babyak, Michael A; O'Connor, Christopher et al. (2012) Effects of exercise training on depressive symptoms in patients with chronic heart failure: the HF-ACTION randomized trial. JAMA 308:465-74
Gardin, Julius M; Leifer, Eric S; Kitzman, Dalane W et al. (2012) Usefulness of Doppler echocardiographic left ventricular diastolic function and peak exercise oxygen consumption to predict cardiovascular outcomes in patients with systolic heart failure (from HF-ACTION). Am J Cardiol 110:862-9
Flynn, Kathryn E; Lin, Li; Moe, Gordon W et al. (2012) Relationships between changes in patient-reported health status and functional capacity in outpatients with heart failure. Am Heart J 163:88-94.e3
Swank, Ann M; Horton, John; Fleg, Jerome L et al. (2012) Modest increase in peak VO2 is related to better clinical outcomes in chronic heart failure patients: results from heart failure and a controlled trial to investigate outcomes of exercise training. Circ Heart Fail 5:579-85
Reed, Shelby D; Li, Yanhong; Dunlap, Mark E et al. (2012) In-hospital resource use and medical costs in the last year of life by mode of death (from the HF-ACTION randomized controlled trial). Am J Cardiol 110:1150-5
Reed, Shelby D; Li, Yanhong; Ellis, Stephen J et al. (2012) Associations between hemoglobin level, resource use, and medical costs in patients with heart failure: findings from HF-ACTION. J Card Fail 18:784-91

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