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

Morten Grundtvig, Torfinn Eriksen-Volnes, Stein Ørn, Eva Kjøl Slind, Lars Gullestad, Morten Grundtvig, Torfinn Eriksen-Volnes, Stein Ørn, Eva Kjøl Slind, Lars Gullestad

Abstract

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.

Keywords: 6 min walk test; Exercise testing; Heart failure; Mortality; Natriuretic peptides; Registry.

Conflict of interest statement

All the authors have nothing to declare with respect to the content of this research.

© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Figures

Figure 1
Figure 1
Scatter diagrams of 6 min walk test (6MWT) related to selected variables.
Figure 2
Figure 2
Kaplan–Meier survival plots of patients with heart failure from the first visit at specialized outpatient heart failure hospital clinics in relation to tertile categories of the 6 min walk test.
Figure 3
Figure 3
Receiver operating characteristic curve showing the value of the 6 min walk test (6MWT) for predicting all‐cause mortality at a median 24 months of follow‐up in outpatients with chronic heart failure. Optimal cut‐point 380 m showing sensitivity of 0.71 and specificity of 0.67.

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