Prognostic value of six-minute walk distance in patients with heart failure: A meta-analysis

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.

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“…Our findings underscore the clinical importance and support the use of 6MWT in the assessment of patients with chronic HF 13,24 …”

Section: Discussionsupporting

confidence: 70%

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

et al. 2020

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“…To date, numerous studies have investigated whether 6MWTD is a prognostic indicator in HF patients. The majority of these studies demonstrated that lower levels of 6MWTD are predictive of mortality in HFrEF 3–16,18 . However, the role of 6MWTD in the prediction of HF hospitalization as an independent event has not been clearly established.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 A number of studies have shown that low 6MWT distance (6MWTD) is associated with increased total mortality and more numerous hospital admissions for HF. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] However, the full prognostic impact of 6MWTD has not been completely elucidated. While it is well known that for 6MWTD 'the lower, the worse', the optimal cut-off value for predicting adverse events is still unclear.…”

Section: Introductionmentioning

confidence: 99%

“…The 6 min walk test (6MWT) provides a reliable and inexpensive way to measure exercise capacity in patients with heart failure (HF) with reduced ejection fraction (HFrEF) 1,2 . A number of studies have shown that low 6MWT distance (6MWTD) is associated with increased total mortality and more numerous hospital admissions for HF 3–19 . However, the full prognostic impact of 6MWTD has not been completely elucidated.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…Больше данных опубликовано о взаимосвязи низких значений ТШХ с повышенной смертностью и/или госпитализацией больных с хроническими заболеваниями легких [16]. Предсказательная ценность ДТШХ продемонстрирована для больных ХСН: по данным метаанализа (13 исследований, n=6076) уменьшение ДТШХ на каждые 50 м повышает риск общей смертности на 18% (95% доверительный интервал (ДИ): 1,07-1,29, p=0,11) и повторной госпитализации на 43% (95% ДИ: 1,10-1,86, р<0,001) [36].…”

Section: повторные тшхunclassified

Six-minute walk test in cardiac rehabilitation

Бубнова¹,

Персиянова-Дуброва²

2020

Cardiovasc Ther Prev

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Six-minute walk test (6MWT) is a simple and safe tool for assessing exercise tolerance in various categories of patients. Currently, 6MWT is used to assess the functional status of a patient and determine the strategy of increasing physical activity, primarily in patients with reduced exercise tolerance and contraindications for cardiopulmonary exercise test. The basic requirements for the 6MWT are presented, taking into account the factors affecting its informativeness and accuracy, as well as the interpretation of results. The diagnostic and prognostic value of 6MWT in different categories of patients are discussed. The prospects for 6MWT use in cardiac rehabilitation for planning rehabilitation program, prescribing exercises, determining the risk of complications, and evaluating the effectiveness are considered. The limitations of 6MWT and ways to overcome it, as well as directions for further research are presented.

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Prognostic value of six-minute walk distance in patients with heart failure: A meta-analysis

Cited by 13 publications

References 9 publications

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

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

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

Six-minute walk test in cardiac rehabilitation

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