Clinical correlates and outcome associated with changes in 6‐minute walking distance in patients with heart failure: findings from the BIOSTAT‐CHF study

Abstract

Background The 6‐minute walk test (6MWT) is a simple and inexpensive way of measuring exercise capacity in patients with heart failure (HF) that predicts morbidity and mortality. However, there are few reports from large multicentre cohorts assessing the predictive value of baseline and changing walk distance. Methods and results In BIOSTAT‐CHF, a 6MWT was performed at baseline (n = 1714) and 9 months (n = 1520). Cox proportional hazards models were used to assess the associations between 6MWT distance and the composite of HF hospitalization and/or death. Median follow‐up was 21 months. The median (pct25‐75) of the 6MWT distance at baseline was 300 m (200–388 m). Independent predictors of a shorter 6MWT distance included older age, female sex, higher heart rate, New York Heart Association class III/IV, orthopnoea, ischaemic heart disease, a previous stroke, current malignancy, and higher N‐terminal pro‐B‐type natriuretic peptide (all P < 0.05). Patients in the lowest baseline 6MWT tertile (≤ 240 m) were less likely to receive guideline‐recommended doses of disease‐modifying therapies (P < 0.05). Compared to patients in the highest baseline 6MWT tertile (> 360 m), those in the lowest and middle tertiles had a worse prognosis [adjusted hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.38–2.18]. Patients with a decrease in the distance walked had a worse prognosis (adjusted HR for each 50 m decrease 1.09, 95% CI 1.06–1.12). 6MWT distance was not modified by treatment up‐titration nor the 6MWT improved the BIOSTAT‐CHF prognostic models. Conclusions The 6‐minute walk test distance at baseline and a decline in walking distance were both associated with worse prognosis but did not improve the prognostic models. 6MWT distance was not modified by treatment up‐titration and its use for assessing the benefits of pharmacologic treatment up‐titration may be limited.

Prognostic Value of the Six-Minute Walk Test in Heart Failure

“…However, performing CPET routinely is expensive and requires specialized and properly trained team. Considering larger studies that used different patterns of group division, worse prognosis was observed in patients who walked less than 360 meters, which makes the 6MWT an independent predictor of mortality in HF [5,11]. We emphasize that our results show convergence with other studies, despite differences regarding sample size and follow-up period.…”

“…13 Nevertheless, its use can be useful in specialized services in clinical practice, as it is an objective and low-cost tool. (12,5) 6 (30,0) 0,09…”

“…The 6-minute walk test (6MWT) assesses the total distance walked over the predetermined time of six minutes, and it is a simple, easy and reproductable method of objectively identifying functional capacity with low cost [3]. The 6MWT has shown to be a good predictor of mortality and hospitalization for HF in long-term studies [4,5] despite that there is still great inconsistency in several studies associations, probably due to the lack of standardized analisys in the performance and interpretation of this test, associated to the population heterogeneity [6]. The present study aimed to assess the impact of the 6MWT as a prognostic marker in patients with HF within one year.…”

February 2019 at a glance: pathophysiology, exercise capacity, diuretics and valve disease

“…Also a decrease in the 6MWT after 9 months was associated with a worse prognosis (adjusted HR for each 50 m decrease 1.09, 95% CI 1.06–1.12). The 6MWT distance was not changed by treatment up‐titration …”

“…The prognostic value of the 6‐minute walk test (6MWT) distance was analysed in the patients enrolled in the systems BIOlogy Study to TAilored Treatment in Chronic HF (BIOSTAT‐CHF) . Patients in the lowest and middle 6MWT tertile had poorer outcomes, compared to those in the highest tertile (>360 m) [adjusted hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.38‐2.18].…”