6 min walk test is a strong independent predictor of death in outpatients with heart failure

Abstract

Aims The aim of this study was to examine the prognostic value of the 6 min walk test (6MWT) in a large cohort of outpatients with heart failure. Methods and results A total of 5519 outpatients with heart failure from the National Norwegian Heart Failure Registry (NNHFR), which is part of the Norwegian Cardiovascular Disease Registry, were included in this analysis. The NNHFR recommended the use of the 6MWT for prognostic assessment of all patients included in the registry. Patients were categorized according to the 6MWT: Category 1 walked the longest and Category 3 the shortest. During a median (25th-75th percentiles) follow-up of 24 (14-36), 12.9% of the patients died. Patients in Category 3 had the overall worst outcome than had patients in Categories 1 and 2. 6MWT used as a continuous variable was a highly significant independent predictor for mortality in a multivariate Cox regression model adjusted for 16 other variables with a hazard ratio of 0.979 [(95% confidence interval 0.972-0.986), P < 0.001]. The four most important predictors for mortality were active cancer in the last 5 years, age, 6MWT, and natriuretic peptides (all P < 0.001). Conclusions 6MWT is a strong independent predictor of mortality in outpatients with HF. The findings support the use of the 6MWT in the prognostic assessment of patients with HF irrespective of HF aetiology.

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

“…A systematic review of 14 studies found that the 6-minute walk test results correlated moderately with peak VO 2 levels and were a reliable and valid indicator of functional capacity in patients with HF who did not walk >490 m. 8 Distance walked in the 6-minute walk test has been associated with prognosis in HF across multiple studies. 9–13,15,16,27 A cutoff of <300 m roughly correlates to patients with NYHA class III to IV symptoms and is associated with worse 3-year survival free of heart transplant (62% versus 82% for those walking ≥300 m). 27 Dyspnea is a complex symptom that can reflect abnormalities in a number of different systems and can be influenced by psychological and environmental factors.…”

Factors associated with long-term adverse cardiovascular events in patients with type 2 diabetes

“…Мнение о прогностической значимости ТШХ поддерживается в других работах при менее продолжительном периоде наблюдения, но у больных с установленной ХСН с нормальной и сниженной ФВ. Так, в крупнейшем исследовании, включавшем 5519 больных, показано, что ТШХ является сильным независимым предиктором смерти в амбулаторных условиях при ХСН в течение двух лет наблюдения [14].…”

Factors associated with lack of improvement in submaximal exercise capacity of patients with heart failure

“…To examine changes in submaximal exercise capacity at patient level, differences between the 6MWT at baseline and after 3 months were calculated per patient. 10 …”

“…The distance walked on the 6MWT is correlated with exercise duration and oxygen uptake at peak exercise and is used to assess interventions or determine subgroups of patients that might benefit from certain interventions 7–9 . The 6MWT has been shown to have a strong predictive power for both mortality and morbidity in patients with HF 10–12 . In a study of 1714 patients with HF, a decline in 6MWT was found to be associated with a worse prognosis and not modified by treatment up‐titration 7 .…”

“… 7 , 8 , 9 The 6MWT has been shown to have a strong predictive power for both mortality and morbidity in patients with HF. 10 , 11 , 12 In a study of 1714 patients with HF, a decline in 6MWT was found to be associated with a worse prognosis and not modified by treatment up‐titration. 7 A threshold of 300 m at the 6MWT is associated with a worse (<300 m) and a better (≥300 m) prognosis in HF patients 11 , 12 and a meaningful improvement in submaximal exercise capacity is previously defined as a change of more than 30 m. 13 An increase of 30 to 50 m in 6MWT distance over time is previously considered a clinically significant improvement and found to be associated with a significant improvement in New York Heart Association functional class (NYHA) and health‐related quality of life.…”