Focus on the Elderly: Two Studies Look at Endurance Training in HFPEF Patients; BAS in PCI Patients

While exercise intolerance is the primary chronic symptom in elderly patients with heart failure and preserved left ventricular ejection fraction (HFPEF), its pathophysiology and treatment options are not well understood.

A study published on July 2 in the Journal of the American College of Cardiology (JACC) provides a closer look at the impacts of endurance exercise training as an option for treating this specific patient group. However, the authors note that "evidence from these same studies consistently support less or no clinical efficacy from clopidogrel therapy among patients who do not smoke."

The study, which looked at 40 stable, compensated HFPEF outpatients between the ages of 63 and 75 over four months, assessed reduced peak oxygen consumption (VO2), during rest and peak upright cycle exercise. Results found peak VO2 was increased with endurance training, associated with a modest increased peak heart rate (139 vs. 131 beats/minute), but no difference in peak end-diastolic volume, stroke volume, or cardiac output. Estimated peak arterial-venous oxygen difference was significantly increased with endurance training. The effect of this training on cardiac output was responsible for less than 15 percent of the improvement in peak VO2.

"In elderly stable compensated HFPEF patients, peak arterial-venous oxygen difference was higher after [endurance training] and was the primary contributor to improved peak VO2," study authors concluded. "This finding suggests that peripheral mechanisms (improved microvascular and/or skeletal muscle function) contribute to the improved exercise capacity after ET in HFPEF." The authors also suggest that future studies may want to look at the intensity and/or type of exercise training as other means of overcoming exercise intolerance.

Additional Resources
  • Journal Scan: Effects of Treatment on Exercise Tolerance, Cardiac Function, and Mortality in HFPEF 
  • Meeting on Demand: Management of HFPEF 
    • 2011 ACCF/AHA/SCAI Guideline for PCI
    • CardioSmart Patient Fact Sheet: Being Active When You Have a Chronic Disease
    • ACC Geriatric Cardiology Member Section
  • Meanwhile, a second study focused on elderly patients evaluated the use of bleeding-avoidance strategies and risk-adjusted bleeding over time in patients undergoing primary percutaneous coronary intervention (PCI). The study, which looked at data from the ACC's National Cardiovascular Data Registry (NCDR) CathPCI Registry from July 1, 2006 through June 30, 2009, found that patients 80 years and older undergoing primary PCI are at high risk of bleeding, and despite significant increases in use of BAS, the overall rate of bleeding complications remains high.


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