Eligibility
major depression, angina, arrhythmia, cognitive impairment, hearing or visual impairment, malignancy, decompensated heart failure, renal disease, psychiatric, hypotension, diabetes
INFLAMMATORY ARTHRITIS, DECOMPENSATED HEART FAILURE, MYOCARDIAL INFARCTION, SHOCKS, ARRHYTHMIA, DISORDERS, RENAL DISEASE, DIABETES, HEART, SYMPTOMATIC AORTIC STENOSIS
Patients with HFrEF (left ventricular ejection fraction < 40%) and New York Heart Association (NYHA) class II or III symptoms aged at least 18 years were eligible for the study. In contrast to the published study protocol, physical inactivity (determined by asking the patient a single-item question) was not considered an eligibility criterion.The exclusion criteria were as follows: (1) signs and symptoms of decompensated heart failure, uncontrolled arrhythmia or effort angina, severe or symptomatic aortic stenosis, or persistent hypotension; (2) recent (< 3 months) myocardial infarction, percutaneous coronary intervention, implantation of an implantable cardioverter defibrillator or bi-ventricular pacemaker, or shocks delivered by the automated implantable cardioverter defibrillator; (3) co-morbid conditions potentially affecting adherence to trial procedures (e.g., inflammatory arthritis, active malignancy, a renal disease requiring dialysis, uncontrolled diabetes, major depression or other significant psychiatric disorders, cognitive impairment, or significant hearing or visual impairment); (4) major surgery planned within the next 12 months; (5) life expectancy shorter than 12 months; (6) inability to walk for any reason; (7) pregnancy; (8) baseline 6-min walking distance > 450 m; and (9) failure to perform the 6MWT.