Clinical correlates and outcome associated with changes in 6-Minute Walking Distance in Patients with Heart Failure: findings from the BIOSTAT-CHF study

João Pedro Ferreira (Lead / Corresponding author), Marco Metra, Stefan D. Anker, Kenneth Dickstein, Chim Lang, Leong Loke Ng, Nilesh J. Samani, John G. F. Cleland, Dirk J. van Veldhuisen, Adriaan A. Voors, Faiez Zannad

Research output: Contribution to journalArticle

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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 (pct 25-75) 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.

Original languageEnglish
Pages (from-to)218-226
Number of pages9
JournalEuropean Journal of Heart Failure
Volume21
Issue number2
Early online date1 Jan 2019
DOIs
Publication statusPublished - Feb 2019

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Walking
Heart Failure
Confidence Intervals
Walk Test
Brain Natriuretic Peptide
Proportional Hazards Models
Myocardial Ischemia
Hospitalization
Therapeutics
Heart Rate
Stroke
Exercise
Morbidity
Mortality
Neoplasms

Keywords

  • 6-minute walk test
  • Heart failure
  • Prognosis

Cite this

Ferreira, João Pedro ; Metra, Marco ; Anker, Stefan D. ; Dickstein, Kenneth ; Lang, Chim ; Ng, Leong Loke ; Samani, Nilesh J. ; Cleland, John G. F. ; van Veldhuisen, Dirk J. ; Voors, Adriaan A. ; Zannad, Faiez. / Clinical correlates and outcome associated with changes in 6-Minute Walking Distance in Patients with Heart Failure : findings from the BIOSTAT-CHF study. In: European Journal of Heart Failure. 2019 ; Vol. 21, No. 2. pp. 218-226.
@article{b36c0e3673b74e30909675015e8ad085,
title = "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 (pct 25-75) 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.",
keywords = "6-minute walk test, Heart failure, Prognosis",
author = "Ferreira, {Jo{\~a}o Pedro} and Marco Metra and Anker, {Stefan D.} and Kenneth Dickstein and Chim Lang and Ng, {Leong Loke} and Samani, {Nilesh J.} and Cleland, {John G. F.} and {van Veldhuisen}, {Dirk J.} and Voors, {Adriaan A.} and Faiez Zannad",
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Ferreira, JP, Metra, M, Anker, SD, Dickstein, K, Lang, C, Ng, LL, Samani, NJ, Cleland, JGF, van Veldhuisen, DJ, Voors, AA & Zannad, F 2019, '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, vol. 21, no. 2, pp. 218-226. https://doi.org/10.1002/ejhf.1380

Clinical correlates and outcome associated with changes in 6-Minute Walking Distance in Patients with Heart Failure : findings from the BIOSTAT-CHF study. / Ferreira, João Pedro (Lead / Corresponding author); Metra, Marco; Anker, Stefan D.; Dickstein, Kenneth; Lang, Chim; Ng, Leong Loke; Samani, Nilesh J.; Cleland, John G. F.; van Veldhuisen, Dirk J.; Voors, Adriaan A.; Zannad, Faiez.

In: European Journal of Heart Failure, Vol. 21, No. 2, 02.2019, p. 218-226.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical correlates and outcome associated with changes in 6-Minute Walking Distance in Patients with Heart Failure

T2 - findings from the BIOSTAT-CHF study

AU - Ferreira, João Pedro

AU - Metra, Marco

AU - Anker, Stefan D.

AU - Dickstein, Kenneth

AU - Lang, Chim

AU - Ng, Leong Loke

AU - Samani, Nilesh J.

AU - Cleland, John G. F.

AU - van Veldhuisen, Dirk J.

AU - Voors, Adriaan A.

AU - Zannad, Faiez

N1 - European Commission. Grant Numbers: FP7‐242209‐BIOSTAT‐CHF, EudraCT 2010–020808–29

PY - 2019/2

Y1 - 2019/2

N2 - 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 (pct 25-75) 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.

AB - 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 (pct 25-75) 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.

KW - 6-minute walk test

KW - Heart failure

KW - Prognosis

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U2 - 10.1002/ejhf.1380

DO - 10.1002/ejhf.1380

M3 - Article

VL - 21

SP - 218

EP - 226

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

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ER -