Association of improvement in functional capacity after rehabilitation with long-term survival in heart failure. (1st April 2022)

• Record Type: Journal Article
• Authors: Scrutinio, Domenico; Guida, Pietro; Passantino, Andrea; Scalvini, Simonetta; Bussotti, Maurizio; Forni, Giovanni; Tibollo, Valentina; Vaninetti, Raffaella; La Rovere, Maria Teresa
• Is Part Of: International journal of cardiology. Volume 352(2022)
• Page Start: 92
• Page End: 97
• Publication Date: 2022-04-01
• Subjects: Heart failure -- Cardiac rehabilitation -- Six-minute walking test -- Prognosis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.01.040
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The prognostic value of change in six-minute walking distance (6MWD) after treatment to predict mortality in heart failure (HF) remains a controversial issue. We assessed the prognostic value of rehabilitation-induced improvement in 6MWD in predicting mortality in patients with HF. Methods: We studied 2257 patients admitted to six inpatient rehabilitation facilities after a hospitalization for HF (N. 912) or because of worsening functional capacity and/or deteriorating clinical status (N. 1345). A six-minute walking test was performed at admission and discharge. The primary outcome was 3-year all-cause mortality after discharge from cardiac rehabilitation. We used multivariable Cox proportional hazard modeling to assess the association of increase in 6MWD with 3-year mortality, adjusting for established predictors of mortality. Results: 6MWD significantly increased by 61 m ( p < .001) from admission to discharge and 969 patients (42.9%) achieved an increase in 6MWD >50 m. After full adjustment, an increase in 6MWD >50 m was associated with a 22% decreased risk for 3-year mortality (HR 0.78 [95% CI 0.68–0.91]; p = .002). When modeled as a continuous variable, improvement in 6MWD remained independently associated with decreased risk for 3-year mortality (HR per each 50 m increase: 0.92 [95% CI 0.88–0.96]). Conclusions: Rehabilitation–induced improvement in 6MWD was associated with a significantly reduced risk for 3-year mortality. Our data also suggest that an improvement in 6MWD of more than 50 m could represent a clinically meaningful endpoint of cardiac rehabilitation for patients with heart failure. Highlights: The prognostic role of improvement in 6-min walk distance in heart failure is a debated issue. We studied 2250 heart failure patients admitted to inpatient cardiac rehabilitation. Rehabilitation-induced improvement in 6-min walk distance predicted improved survival. This finding can contribute to promote cardiac rehabilitation referral for heart failure.