title: Pre-Discharge Evaluation in Heart Failure – Additive Predictive Value of the 6-Minute Walking Test to Clinical Scores.
abstract: BACKGROUND
  We aimed to investigate whether the assessment of functional capacity by the 6-minute walking test (6MWT) might improve the predictive ability of 2 validated clinical scores for risk stratification in heart failure (HF).
  
  
  RESULTS
  The Cardiac and Comorbid Conditions HF (3C-HF) and the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) scores were evaluated in 466 consecutive HF patients who completed a pre-discharge 6MWT. The 12-month event rate was 7.7%. Both the 2 scores and the 6MWT predicted all-cause mortality (all P<0.0001), with a hazard ratio of 2.650 [95%CI 1.879-3.737], 2.754 [95%CI 1.870-4.056] for each one SD increase in the 3C-HF and MAGGIC, respectively, and of 2.080 [95% CI 1.619-2.671] for each one SD decrease in the meters walked. The addition of a 6MWT to both the 3C-HF and MAGGIC scores significantly improved predictive discrimination (c-index 0.793 [95% CI 0.722-0.864] and 0.802 [95% CI 0.733-0.871], respectively) and risk classification (integrated discrimination improvement, IDI 0.052 [95% CI 0.024-0.101] and 0.046 [95% CI 0.020-0.102], respectively). In the intermediate and high risk strata identified on the basis of both the 3C-HF and MAGGIC scores, mortality rates significantly differed according to a distance walked < or ≥376 m.
  
  
  CONCLUSIONS
  In HF patients, a pre-discharge evaluation combining the 6MWT to clinical scores improves prediction of 12-month mortality.
authors.affiliation: Division of Cardiology, Fondazione "Salvatore Maugeri", Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Scientifico di Montescano.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: La Rovere
authors.forename: Roberto
authors.initials: R
authors.lastname: Maestri
authors.forename: Angelo
authors.initials: A
authors.lastname: Caporotondi
authors.forename: Daniela
authors.initials: D
authors.lastname: Corbellini
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Guazzotti
authors.forename: Gian Domenico
authors.initials: GD
authors.lastname: Pinna
authors.forename: Oreste
authors.initials: O
authors.lastname: Febo
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D016138:Walking