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Learning Objective 1: The learner will be able to describe the relationship between six-minute walk tests and event-free survival in persons after an acute heart failure hospitalization.
Learning Objective 2: The learner will be able to understand how nurses may use six-minute walk tests to guide discharge planning in persons during acute heart failure hospitalization.
Background:
Distance walked on six-minute walk tests (6MWD) is known to predict event-free survival in ambulatory populations of heart failure (HF) patients, but its ability to predict event-free survival following acute HF hospitalization is poorly understood.1 The purpose of this study is to determine whether 6MWD prior to discharge from an acute HF hospitalization is predictive of event-free survival.
Methods:
A secondary analysis of 55 persons with NYHA Class II-III HF (mean age 51 years [SD 13], 65% male, 64% African American, 62% length of diagnosis ≥ 5 years, mean LVEF 24.8% [SD 13.6],) from an on-going HF trial was conducted. Kaplan-Meier and Cox regression analyses were used to determine the relationship between event-free survival (event=transplant or listed, death, LVAD, or HF rehospitalization) and 6WMD prior to hospital discharge.
Results:
During an average follow-up of 130 days [SD 98], 34 events occurred in 25 (45%) persons (death=5, transplant/listed=3, LVAD=2, HF rehospitalization=24). Event-free survival was 76%, 65%, 56% at 30, 60, and 90 days after HF hospitalization. Overall mean 6MWD was 886 feet [SD 405]. Persons with an event had lower mean 6MWD (778 feet [SD 412]) than persons without an event (977 feet [SD 384]), but this was not significant (t(53)=1.85, p=.07). Time to first event was significantly related to 6MWD (χ2 4.59, p=0.03), which remained significant after adjusting for LVEF, race, length of diagnosis, and the Enhanced Feedback for Effective Cardiac Treatment Score, a commonly employed HF mortality risk score and calculated using age, laboratory values, vital signs, and comorbidities (χ2 7.39, p=.02).
Conclusions:
6MWD is a simple, feasible assessment that is independently predictive of event-free survival following acute HF hospitalization. Further study is warranted regarding the use of the 6MWD to predict adverse events, guide treatment decisions, and discharge planning including timing of discharge in persons with HF.