Prognostic impact of 6 min walk test distance in patients with systolic heart failure: insights from the WARCEF trial

Abstract

Aims This study aimed to investigate the impact of baseline 6 min walk test distance (6MWTD) on time to major cardiovascular (CV) events in heart failure with reduced ejection fraction (HFrEF) and its impact in clinically relevant subgroups. Methods and results In the WARCEF (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction) trial, 6MWTD at baseline was available in 2102 HFrEF patients. Median follow-up was 3.4 years. All-cause death and heart failure hospitalization (HFH) exhibited a significant non-linear relationship with 6MWTD (P = 0.023 and 0.032, respectively), whereas a significant association between 6MWTD and CV death was shown in a linear model [hazard ratio (HR) per 10 m increase, 0.989; P = 0.011]. In linear splines with the best cutoff point at 200 m, the positive effect of a longer 6MWTD on all-cause death and HFH was only observed for 6MWTD > 200 m (HR per 10 m increase, 0.987; P = 0.0036 and 0.986; P = 0.0022, respectively). The associations between 6MWTD and CV outcomes were consistent across clinical subgroups; for age, a significant relationship between 6MWTD and HFH was observed in patients ≥60 years (HR per 10 m increase, 0.98; P < 0.001), but not in patients <60 years (HR per 10 m increase, 1.00; P = 0.98; P = 0.02 for the interaction). Conclusions In HFrEF, 6MWTD is independently associated with all-cause death, CV death, and HFH. 6MWTD of 200 m is the best cutoff point for predicting these adverse events. The prognostic impact of 6MWTD for HFH was only observed in older patients.

Delivering effective, comprehensive, multi-exercise component cardiac rehabilitation (CR) for chronic heart failure patients in low resource settings in sub-Saharan Africa: Queen Elizabeth Central Hospital—(QECH-CR) randomised CR study, Malawi

“…Combining both ET and lifestyle targeted education and counselling in CR as it is widely promoted [12,21], appear a very effective strategy for treating CHF. A 10m increase in walking distance has been associated with nearly 2% reduction in three-and half-year risk for CVD-related mortality [47]. In their findings from a multicentre study, in which 14% of participants were blacks, Matsumoto et al [47] identified 200 m as an optimal cut-off point for predicting cardiac events; which corresponds with findings from other worldwide investigators [48][49][50].…”

“…A 10m increase in walking distance has been associated with nearly 2% reduction in three-and half-year risk for CVD-related mortality [47]. In their findings from a multicentre study, in which 14% of participants were blacks, Matsumoto et al [47] identified 200 m as an optimal cut-off point for predicting cardiac events; which corresponds with findings from other worldwide investigators [48][49][50]. Therefore, our findings suggest that ET, delivered in this resource-limited setting, may significantly reduce the risk for future cardiac events within higher risk groups and patients with CHF.…”

Proposed Cardiac End Points for Clinical Trials in Immunoglobulin Light Chain Amyloidosis: Report From the Amyloidosis Forum Cardiac Working Group

“…28 An improvement of 33 meters is generally considered clinically meaningful in cardiopulmonary disorders. 27,64 In patients with AL amyloidosis, preliminary data suggest a 33-meter improvement was independent of hematologic response in predicting survival and improvement at 12 months was only observed in patients who achieved complete hematologic response. 28 Data on the temporal evolution of the 6MWT in AL amyloidosis is limited.…”