Key result
Severe functional impairment on 6MWT is linked to ~158% higher 1-year mortality in HF.
Why the study?
Although natriuretic peptides are recognized as the most powerful predictors of adverse outcomes in HF, it was hypothesized that functional limitation assessed by 6MWT would improve the accuracy of a prognostic model incorporating NP.
Does severe functional impairment assessed by the 6-minute walking test predict 1-year all-cause mortality in heart failure patients admitted to cardiac rehabilitation?
Observational (n=1,696)
Yes
Does severe functional impairment assessed by the 6-minute walking test predict 1-year all-cause mortality in heart failure patients admitted to cardiac rehabilitation?
Effect estimate: OR 2.58 (95% CI 1.72-3.88)
Absolute Event Rate: 23% vs 5%
p-value: p=<0.001
Severe functional impairment assessed by the 6-minute walking test provides strong, incremental prognostic value for 1-year mortality over established risk markers like NT-proBNP and the MAGGIC score in heart failure patients.
Natriuretic peptides (NP) are recognized as the most powerful predictors of adverse outcomes in heart failure (HF). We hypothesized that a measure of functional limitation, as assessed by 6-min walking test (6MWT), would improve the accuracy of a prognostic model incorporating a NP. This was a multicenter observational retrospective study. We studied the prognostic value of severe functional impairment (SFI), defined as the inability to perform a 6MWT or a distance walked during a 6MWT < 300 m, in 1696 patients with HF admitted to cardiac rehabilitation. The primary outcome was 1-year all-cause mortality. After adjusting for the baseline multivariable risk model-including age, sex, systolic blood pressure, anemia, renal dysfunction, sodium level, and NT-proBNP-or for the MAGGIC score, SFI had an odds ratio of 2.58 (95% CI 1.72-3.88; p < 0.001) and 3.12 (95% CI 2.16-4.52; p < 0.001), respectively. Adding SFI to the baseline risk model or the MAGGIC score yielded a significant improvement in discrimination and risk classification. Our data suggest that a simple, 6MWT-derived measure of SFI is a strong predictor of death and provide incremental prognostic information over well-established risk markers in HF, including NP, and the MAGGIC score.
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Scrutinio et al. (2024) conducted an observational in Chronic heart failure (n=1,696). Severe functional impairment (SFI) on 6-minute walking test vs. No severe functional impairment was evaluated on 1-year all-cause mortality (OR 2.58, 95% CI 1.72-3.88, p=<0.001). Severe functional impairment, assessed by the 6-minute walking test, was associated with a 2.58-fold increased odds of 1-year mortality compared to no severe impairment in patients with heart failure.
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