Background: In the multicenter, randomized REHAB-HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) trial, older hospitalized patients with decompensated heart failure (HF) who participated in an early, transitional, tailored, progressive, and multidomain physical rehabilitation intervention demonstrated significant improvements in physical function and quality of life (QOL). Prevalence of depression is high in HF, but it is unknown whether older patients with concomitant HF and depression who undergo rehabilitation have similar improvements in outcomes. Objective: We assessed for physical function and QOL differences in intervention outcomes among patients with and without baseline depression. Methods: REHAB-HF included patients > 60 years hospitalized for HF and randomized them to a physical rehabilitation intervention or attention control. Participants were stratified across baseline depression status using the Geriatric Depression Scale (GDS, ≥5). Primary outcomes included physical function measured with the Short Physical Performance Battery (SPPB) score and health-related (HR) QOL measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) at 3 months. Clinical outcomes included all-cause/HF hospitalizations or mortality at 6 months. Results: Out of 343 participants (mean±SD age 73±8, 52.2% female), 44.6% (n=153) had depression. Those with depression had higher BMI (34.2±8.8 vs. 31.8±8.2, p=0.01), had EF > 45% (61.4% vs. 47.9%, p=0.01) and were frail (54.9% vs. 38.9%, p=0.003). Adherence to rehab intervention did not differ for participants with and without depression. Participants demonstrated improvements in SPPB with the intervention with (Effect Size 1.4; 95% CI 0.5, 2.3; p=0.002) and without (1.5; 0.7, 2.3; p=0.0001) depression. There was a trend toward a larger intervention effect size for HRQOL, with significant improvement among patients with (11.6; 3.9, 19.3; p=0.003) vs. without depression (3.2; -3.6, 10.0, p=0.4) as measured by KCCQ. No differences in clinical outcomes were seen. Conclusions: Older HF patients with and without depression had similar adherence and demonstrated significant improvements in physical function in response to intervention. Those with depression also demonstrated significant improvements in HRQOL. These findings suggest that physical rehabilitation may improve physical function and HRQOL in older patients with comorbid depression during recovery from acute HF decompensation.

BACKGROUND:A multidomain physical rehabilitation intervention (REHAB-HF [Rehabilitation Therapy in Older Acute Heart Failure Patients] intervention) has been associated with significant improvements in physical function and quality of life (QOL) among older patients with acute decompensated heart failure (ADHF). OBJECTIVES:This study aims to evaluate sex differences in the treatment effect of a multidomain rehabilitation intervention among participants of the REHAB-HF trial. METHODS:In this prespecified secondary analysis of the REHAB-HF trial, sex differences in the treatment effect of the REHAB-HF intervention (vs attention control) on key 3-month outcomes of the Short Physical Performance Battery (SPPB, primary), frailty burden, 6-minute walking distance (6MWD), and QOL were assessed. Statistical significance for treatment effect interaction (sex∗intervention) was set at 0.1. RESULTS:Among the 349 trial participants, female patients (n = 183) had a significantly lower baseline SPPB score and 6MWD and a higher frailty burden than male patients (n = 166). Female (vs male) participants had a significantly greater improvement in SPPB (effect size: 1.9 [95% CI: 1.1-2.7] vs 1.0 [95% CI: 0.1-1.8]; P for interaction = 0.1) and frailty burden, as assessed by Fried phenotype criteria (effect size: -0.5 [95% CI: -0.9 to -0.2] vs 0.00 [95% CI: -0.4 to 0.4]; P for interaction = 0.04) with the REHAB-HF intervention. The magnitude of the improvement in 6MWD and QOL (Kansas City Cardiomyopathy Questionnaire score) with the REHAB-HF intervention was also greater among female (vs male) participants without a significant treatment effect interaction by sex. There was no significant difference in rates of adverse clinical outcomes associated with the intervention across both sex groups. There was no difference in intervention adherence by sex. CONCLUSIONS:Female (vs male) participants with ADHF had a significantly greater improvement in physical function in response to the REHAB-HF intervention.

Introduction The ecosystem of heart failure (HF) clinical research faces numerous challenges, such as significant time commitment and financial costs, complex trial design and regulatory processes, low return on investment, and poor incentives for investigators and research teams to participate. In 2017, a multidisciplinary group of academic investigators, industry representatives, professional society leaders, patients, and government representatives convened to form the Heart Failure Collaboratory (HFC), a public-private partnership with the FDA aimed at improving the efficiency of HF clinical trials. In this context, the HFC has worked on strategies to incentivize research teams and provide meaningful recognition of meritorious work to cultivate and retain more engaged investigators and research teams. Since 2019, the HFC has partnered with the Heart Failure Society of America (HFSA) in a national awards program which highlights and promotes the outstanding work of principal investigators (PIs) and site coordinators (SCs) in the conduct of HF clinical trials. We aimed to measure the impact of these awards to date. Methods The HFC working group developed a four-question survey to gauge past awardees' views of the awards, the impact of winning an award on their career, and how future awardees might best be recognized. The survey was sent to all past award recipients. Results The survey was delivered successfully to all 57 site PI awardees and 33 of 54 SC (61%) awardees. Ten SCs and 24 PIs completed the survey, for an overall response rate of 38% (42% among PIs and 30% among SCs). All respondents acknowledged that recognition with a Site-Based Research Award was at least "somewhat meaningful," with 27 awardees (79%) classifying the awards as "very meaningful." Most respondents (88%, n=30) have their Research Award listed on their curriculum vitae. Five SCs (50%) referenced their award in performance reviews or career advancement discussions. Eight SCs (80%) and 9 PIs (38%) received some form of additional recognition from their home institution related to this award. Over one-third (35%, n=12) of respondents posted news of their award on social media (Figure). When asked about preferences for recognition type, feedback varied by individual responder with no clear consensus. Conclusion Public recognition by organizations like the HFC and HFSA is likely important and meaningful to members of research teams, including both PIs and SCs. Finding creative ways to encourage, recognize, and reward significant contributions to the research community may be one mechanism to increase engagement among research teams and improve clinical trial efficiency.

Background The REHAB‐HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) trial demonstrated that a transitional, tailored, progressive rehabilitation intervention improved physical function, 6‐minute walk distance, frailty, quality‐of‐life, and depression in older patients hospitalized for acute decompensated heart failure. This analysis assessed the impact of atrial fibrillation (AF) on intervention benefits. Methods and Results Of 349 enrolled patients hospitalized for acute decompensated heart failure (mean age 72.7±8.1 years), 176 (50.4%) had AF. Participants were randomly assigned to 12‐week rehabilitation intervention or attention control. The primary outcome was Short Physical Performance Battery score at 3 months. Participants with AF were older (74.4±8.3 versus 70.8±7.5, P<0.0001) and had higher prevalence of heart failure with preserved ejection fraction (58.5% versus 47.4%, P=0.037). Patients with and without AF had similar improvement in Short Physical Performance Battery score (mean difference between rehabilitation intervention and attention control, 1.5 [95% CI, 0.6–2.3] versus 1.5 [95% CI, 0.7–2.3]; P<0.001). Those with AF had significant improvement in 6‐minute walk distance (all P<0.05) and each of the Short Physical Performance Battery domains: balance, 4‐meter walk, and chair rise. Kansas City Cardiomyopathy Questionnaire score significantly improved in patients with AF (P<0.05) but not those without AF (P>0.05). Interaction P values for 3‐month outcomes by AF status were not significant (P>0.1). No significant differences were observed in deaths, all‐cause rehospitalizations, or heart failure hospitalizations at 6 months. Conclusions In older, hospitalized patients with acute decompensated heart failure, the presence of AF did not significantly affect the benefit of the rehabilitation intervention on physical function and quality of life. The intervention appears safe and effective regardless of AF status. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02196038.

Introduction: Circulating biomarkers play an important role in patients with heart failure (HF) for risk stratification and mechanistic insights. We aimed to examine if a diverse set of biomarkers in the REHAB-HF trial would predict improvement in physical function following a 12-week tailored physical therapy rehabilitation intervention compared to attention control. Methods: The study population consisted of participants ≥60 years of age who were hospitalized with acute HF and randomized to a subsequent multidomain outpatient physical rehabilitation intervention vs. attention control with outcomes of 12-week functional change including the Short Physical Performance Battery (SPPB) and six-minute walk distance (6MWD). Blood was collected prior to randomization and at 12-weeks for cardiac, renal, and inflammatory biomarkers. Linear trends across progressively higher biomarker values versus improvement in functional outcomes based on treatment assignment were evaluated. Classification and regression trees (CART) were created to estimate optimal biomarker levels associated with differential improvement in the two functional outcomes. Results: A total of 242 of 349 participants (69%) had baseline biomarkers measured. In an adjusted regression model, higher baseline cardiac troponin (cTn) I and T were associated with greater gains in SPPB and 6MWD respectively with the rehabilitation intervention (P=0.04 and 0.03 for interaction) versus attention control. In the CART analysis of the physical rehabilitation and attention control participants, those with baseline C-reactive protein (CRP) ≥9.9 mg/L and hs-cTnT ≥36 ng/L receiving the rehabilitation intervention had a 129 m (95% CI 78-180m) greater 12-week 6MWD increase vs attention control. In contrast, for participants with CRP<9.9 mg/L there was no significant incremental 6MWD difference (30m, 95% CI -0.5m, 60.2m). For SPPB, a CRP ≥9.9 mg/L and creatinine ≥1.4 mg/dL optimally identified a differential improvement with the rehabilitation intervention versus attention control. The biomarkers (except for creatinine) decreased by 12 weeks post hospitalization but with no differences based on treatment assignment. Conclusion: Higher baseline levels of biomarkers of inflammation, cardiac injury, and renal dysfunction identified older adults after a HF hospitalization with the greatest differential improvement in physical function with a rehabilitation intervention. Biomarkers may help clinicians predict the benefits of this treatment. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial REHAB-HF ClinicalTrials.gov number, [NCT02196038][1] ### Funding Statement Funded in part by Career Development Award K23-HL153771-01 Funded by the National Institutes of Health and others; REHAB-HF ClinicalTrials.gov number, [NCT02196038][1] ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The institutional review board at Inova Health has approved this study. The study was also approved independently by each of the participating sites of the Rehab-HF Trial. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes "All data referred to in this manuscript are subject to restrictions imposed by the funders and will not be publicly available. However, all R output and associated code used for the analysis have been made publicly accessible to ensure transparency and reproducibility. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02196038&atom=%2Fmedrxiv%2Fearly%2F2024%2F09%2F15%2F2024.09.13.24313662.atom

HomeCirculationAhead of PrintPhysical Activity for Patients with Heart Failure with Reduced Ejection Fraction: Pump up the Volume No AccessEditorialRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessEditorialRequest AccessPhysical Activity for Patients with Heart Failure with Reduced Ejection Fraction: Pump up the Volume David J. Whellan David J. WhellanDavid J. Whellan * Corresponding Author; email: E-mail Address: [email protected] https://orcid.org/0000-0002-6287-8690 Thomas Jefferson University, Philadelphia, PA Originally published13 Nov 2023https://doi.org/10.1161/CIRCULATIONAHA.123.067588Circulation. 2023;0Footnotes* Corresponding Author; email: david.whellan@jefferson.edu eLetters(0) eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate. Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page. Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article Information Metrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.123.067588PMID: 37955620 Manuscript receivedNovember 3, 2023Manuscript acceptedNovember 7, 2023Originally publishedNovember 13, 2023 PDF download Advertisement

U.S. News and World Report 2022–2023 hospital rankings were used to investigate the leadership practices and organizational structure of ranked healthcare institutions. Institutional variables including physician leadership status, executive board size, number of physician board members, type of physician practice, health system size, and for-profit status were collected. US News and World Report scores were used to create a comprehensive institutional rank order list. Strength of association was evaluated between these variables and the organization’s US News and World Report rank. Our analysis included 546 institutions representing 1676 hospitals. Leadership under a physician CEO (OR 1.59 (95

Background The REHAB‐HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) randomized trial demonstrated that a 3‐month transitional, tailored, progressive, multidomain physical rehabilitation intervention improves physical function, frailty, depression, and health‐related quality of life among older adults with acute decompensated heart failure. Whether there is differential intervention efficacy by race is unknown. Methods and Results In this prespecified analysis, differential intervention effects by race were explored at 3 months for physical function (Short Physical Performance Battery [primary outcome], 6‐Minute Walk Distance), cognition, depression, frailty, health‐related quality of life (Kansas City Cardiomyopathy Questionnaire, EuroQoL 5‐Dimension‐5‐Level Questionnaire) and at 6 months for hospitalizations and death. Significance level for interactions was P≤0.1. Participants (N=337, 97% of trial population) self‐identified in near equal proportions as either Black (48%) or White (52%). The Short Physical Performance Battery intervention effect size was large, with values of 1.3 (95% CI, 0.4–2.1; P=0.003]) and 1.6 (95% CI, 0.8–2.4; P<0.001) in Black and White participants, respectively, and without significant interaction by race (P=0.56). Beneficial effects were also demonstrated in 6‐Minute Walk Distance, gait speed, and health‐related quality of life scores without significant interactions by race. There was an association between intervention and reduced all‐cause rehospitalizations in White participants (rate ratio, 0.73 [95% CI, 0.55–0.98]; P=0.034) that appears attenuated in Black participants (rate ratio, 1.06 [95% CI, 0.81–1.41]; P=0.66; interaction P=0.067). Conclusions The intervention produced similarly large improvements in physical function and health‐related quality of life in both older Black and White patients with acute decompensated heart failure. A future study powered to determine how the intervention impacts clinical events is required. REGISTRATION URL: https://www.clinicaltrials.gov. Identifier: NCT02196038.

Background Volitional physical activity level is predictive of a variety of health outcomes, but has not been examined in patients recently hospitalized for acute decompensated HF (ADHF).Methods Ten to 14 days after index hospitalization for ADHF, 93 participants wore a wrist-mounted triaxial accelerom-eter (ActiGraph GT3X +) to objectively quantify sedentary behavior, light physical activity, and moderate-to-vigorous physical activity. Levels were compared to 2 groups of age-matched NHANES participants: healthy and chronic, stable HF. The relationship between physical activity levels and physical function [Short Physical Performance Battery (SPPB)], HF-specific quality-of-life (QOL) [Kansas City Cardiomyopathy Questionnaire (KCCQ)], and cognition [Montreal Cognitive Assessment (MOCA)] were examined.Results ADHF participants accumulated a median 1,008 (IQR 896, 1,109) minutes of sedentary time, 88 (57, 139) minutes of light physical activity, and 10 (6, 25) minutes of moderate-to-vigorous physical activity per day. Sedentary time, light physical activity, or moderate-to-vigorous activity did not differ by sex or EF subtype. ADHF participants spent only 9% of awake time nonsedentary, compared to 34% and 27% for healthy adults and adults with chronic, stable HF, respectively. Among ADHF participants, SPPB, KCCQ, and MOCA scores did not differ among quartiles of total physical activity.Conclusions Older patients recently hospitalized for ADHF have very low levels of physical activity and high levels of sedentary time, both of which may be potential targets for interventions in this high-risk population. Physical activity level was not significantly associated with objectively measured physical function, QOL, or cognition, suggesting that this measure provides independent information regarding the patient experience of living with HF.Trial Registration NCT02196038, https://clinicaltrials.gov/ct2/show/NCT02196038 (Am Heart J 2023;256:85-94.)

Background: Patient-reported quality of life (QoL) assessments, such as the Kansas City Cardiomyopathy Questionnaire (KCCQ) or Minnesota Living with Heart Failure Questionnaire (MLHFQ), reflect an individual’s health status and symptom severity at a given timepoint, and may have utility as inclusion criteria in heart failure (HF) clinical trials. Method: The Heart Failure Collaboratory-Academic Research Consortium, a group of stakeholders including patients, investigators, and representatives from government and industry, convened to review data from multiple HF clinical trials discuss the use of patient reported QoL-based inclusion criteria in clinical trials of HF. Result: Patient-reported QoL assessments, such as the KCCQ, have high test-retest reliability and, in contrast with the physician-assigned New York Heart Association (NYHA) class, are not subject to clinician bias or influenced by knowledge of prognostic variables such as Left Ventricular Ejection Fraction (LVEF) or N-terminal pro B-type Natriuretic Peptide (NT-proBNP). The U.S. FDA has qualified KCCQ as an effective clinical outcomes assessment for HF, and recent clinical trials that demonstrated substantial reductions in morbidity and mortality also showed improvements in KCCQ scores, provided patients had a decrement at baseline. However, KCCQ use is limited by both complicated clinical interpretability, with total symptom score consisting of aggregate scores from different physical and symptomatic domains and uncertainty around the threshold of clinically important difference, and by its length, with average completion time of 5 to 8 minutes. Conclusion: Patient-reported functional assessments have potential as inclusion criteria in clinical trials of HF by ensuring the enrollment of patients with a diminished QoL who have the potential to improve in response to therapeutic intervention, especially in clinical trials with QoL-based endpoints.

BACKGROUND:We sought to determine whether circulating modifiers of endothelial function are associated with cardiac structure and clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF). METHODS:We measured 25 proteins related to endothelial function in 99 patients from the GUIDE-IT study. Protein levels were evaluated for association with echocardiographic parameters and the incidence of all-cause death and hospitalization for heart failure (HHF). RESULTS:Higher concentrations of angiopoietin 2 (ANGPT2), vascular endothelial growth factor receptor 1 (VEGFR1) and hepatocyte growth factor (HGF) were significantly associated with worse function and larger ventricular volumes. Over time, decreases in ANGPT2 and, to a lesser extent, VEGFR1 and HGF, were associated with improvements in cardiac size and function. Individuals with higher concentrations of ANGPT2, VEGFR1 or HGF had increased risks for a composite of death and HHF in the following year (HR 2.76 (95% CI 1.73-4.40) per 2-fold change in ANGPT2; HR 1.76 (95% CI 1.11-2.79) for VEGFR1; and HR 4.04 (95% CI 2.19-7.44) for HGF). CONCLUSIONS:Proteins related to endothelial function associate with cardiac size, cardiac function and clinical outcomes in patients with HFrEF. These results support the concept that endothelial function may be an important contributor to the progression to and the recovery from HFrEF.

BACKGROUND:Although clinical studies have demonstrated the association between a single N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement and clinical outcomes in chronic heart failure, the biomarker is frequently measured serially in clinical practice. OBJECTIVES:The aim of this study was to determine the added prognostic value of repeated NT-proBNP measurements compared with single measurements alone for chronic heart failure patients. METHODS:In the GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure) study, 894 study participants with chronic heart failure with reduced ejection fraction were enrolled at 45 outpatient sites in the United States and Canada. Repeated NT-proBNP levels were measured over a 2-year study period. Associations between repeated NT-proBNP measurements and trial endpoints were assessed using a joint longitudinal and survival model. RESULTS:After adjustment for baseline covariates, each doubling of the baseline NT-proBNP level was associated with a HR of 1.17 (95% CI: 1.08-1.28; P = 0.0003) for the primary trial endpoint of cardiovascular death or heart failure hospitalization. Serial measurements increased the adjusted HR for the primary trial endpoint to 1.66 (95% CI: 1.50-1.84; P < 0.0001), and a similar increased risk was observed across secondary trial endpoints. In joint modeling, an increase in NT-proBNP occurred weeks before the onset of adjudicated events. CONCLUSIONS:Repeated NT-proBNP measurements are a strong predictor of outcomes in heart failure with reduced ejection fraction with an increase in concentration occurring well before event onset. These results may support routine NT-proBNP monitoring to assist in clinical decision making. (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure [GUIDE-IT]; NCT01685840).

Importance:Frailty is common among older patients with acute decompensated heart failure (ADHF) and is associated with worse quality of life (QOL) and a higher risk of clinical events. Frailty can also limit recovery and response to interventions. In the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial, a 3-month innovative, early, transitional, tailored, multidomain physical rehabilitation intervention improved physical function and QOL (vs usual care) in older patients with ADHF. Objective:To evaluate whether baseline frailty modified the benefits of the physical rehabilitation intervention among patients with ADHF enrolled in the REHAB-HF trial and to assess the association between changes in frailty with the risk of adverse clinical outcomes on follow-up. Design, Setting, and Participants:This prespecified secondary analysis of the REHAB-HF trial, a multicenter randomized clinical trial, included 337 patients 60 years and older hospitalized for ADHF. Patients were enrolled from September 17, 2014, through September 19, 2019. Participants were stratified across baseline frailty strata as assessed using modified Fried criteria. Data were analyzed from July 2021 to September 2022. Interventions:Physical rehabilitation intervention or attention control. Main Outcomes and Measures:Primary outcome was the Short Physical Performance Battery (SPPB) score at 3 months. Clinical outcomes included all-cause hospitalization or mortality at 6 months. Results:This prespecified secondary analysis included 337 participants; 181 (53.7%) were female, 167 (49.6%) were Black, and the mean (SD) age was 72 (8) years. A total of 192 (57.0%) were frail and 145 (43.0%) were prefrail at baseline. A significant interaction was observed between baseline frailty status and the treatment arm for the primary trial end point of overall SPPB score, with a 2.6-fold larger improvement in SPPB with intervention among frail patients (2.1; 95% CI, 1.3-2.9) vs prefrail patients (0.8; 95% CI, -0.1 to 1.6; P for interaction = .03). Trends consistently favored a larger intervention effect size, with significant improvement among frail vs prefrail participants for 6-minute walk distance, QOL, and the geriatric depression score, but interactions did not achieve significance. Conclusions and Relevance:In this prespecified secondary analysis of the REHAB-HF trial, patients with ADHF with worse baseline frailty status had a more significant improvement in physical function in response to an innovative, early, transitional, tailored, multidomain physical rehabilitation intervention than those who were prefrail. Trial Registration:Clinical Trials.gov Identifier: NCT02196038.

PURPOSE:Suboptimal adherence is a major limitation to achieving the benefits of exercise interventions, and our ability to predict and improve adherence is limited. The purpose of this analysis was to identify baseline clinical and demographic characteristics predicting exercise training adherence in the HF-ACTION study cohort.METHODS:Adherence to exercise training, defined by the total duration of exercise performed (min/wk), was evaluated in 1159 participants randomized to the HF-ACTION exercise intervention. More than 50 clinical, demographic, and exercise testing variables were considered in developing a model of the min/wk end point for 1-3 mo (supervised training) and 10-12 mo (home-based training).RESULTS:In the multivariable model for 1-3 mo, younger age, lower income, more severe mitral regurgitation, shorter 6-min walk test distance, lower exercise capacity, and Black or African American race were associated with poorer exercise intervention adherence. No variable accounted for >2% of the variance and the adjusted R2 for the final model was 0.14. Prediction of adherence was similarly limited for 10-12 mo.CONCLUSIONS:Clinical and demographic variables available at the initiation of exercise training provide very limited information for identifying patients with heart failure who are at risk for poor adherence to exercise interventions.