João Pedro Ferreira1,2, Marco Metra3, Stefan D Anker4, Kenneth Dickstein5,6, Chim C Lang7, Leong Ng8, Nilesh J Samani9, John G Cleland10, Dirk J van Veldhuisen11, Adriaan A Voors11, Faiez Zannad1. 1. INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France. 2. Cardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal. 3. University of Brescia, Brescia, Italy. 4. Department of Innovative Clinical Trials, University Medical Centre Göttingen (UMG), Göttingen, Germany. 5. University of Bergen, Bergen, Norway. 6. Stavanger University Hospital, Stavanger, Norway. 7. Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK. 8. Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK. 9. Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK. 10. National Heart and Lung Institute, Imperial College London, London, UK; and Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK. 11. University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
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.
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.
Authors: Iván José Fuentes-Abolafio; Brendon Stubbs; Luis Miguel Pérez-Belmonte; María Rosa Bernal-López; Ricardo Gómez-Huelgas; Antonio Ignacio Cuesta-Vargas Journal: BMC Cardiovasc Disord Date: 2020-12-09 Impact factor: 2.298
Authors: Kenji Matsumoto; Yi Xiao; Shunichi Homma; John L P Thompson; Richard Buchsbaum; Kazato Ito; Stefan D Anker; Min Qian; Marco R Di Tullio Journal: ESC Heart Fail Date: 2020-12-30