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

European Journal of Heart Failure - Tập 21 Số 2 - Trang 218-226 - 2019
João Pedro Ferreira1,2, Marco Metra3, Stefan D. Anker4, Kenneth Dickstein5,6, Chim C. Lang7, Leong L. Ng8,9, Nilesh J. Samani10, John G.F. Cleland11,12, Dirk J. van Veldhuisen13, Adriaan A. Voors13, Faı̈ez Zannad2
1Cardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
2INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F‐CRIN INI‐CRCT Nancy France
3University of Brescia, Brescia, Italy
4Department of Innovative Clinical Trials University Medical Centre Göttingen (UMG) Göttingen Germany
5Stavanger University Hospital, Stavanger, Norway
6University of Bergen, Bergen, Norway
7Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
8Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
9Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; and NIHR Leicester Cardiovascular Biomedical Research Unit Glenfield Hospital Leicester UK
10Department of Cardiovascular Sciences University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital Leicester UK
11National Heart and Lung Institute, Imperial College London, London, UK; and Robertson Centre for Biostatistics and Clinical Trials University of Glasgow Glasgow UK
12Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK
13University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands

Tóm tắt

AbstractBackgroundThe 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 resultsIn 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.ConclusionsThe 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.

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European Journal of Heart Failure

Tập 21 Số 2

218-226

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