The six-minute walk test prognostic value in heart failure patients

Introduction. Heart failure is one of the most common non-communicable diseases. A non-invasive stress test for diagnosing this disease is the six-minute walk test. This research method is a promising method for determining the heart failure prognosis.
Aim. To analyze scientific data on the assessment of the six-minute walk test prognostic role in heart failure patients. Materials and methods. The material was searched in the electronic databases eLIBRARY.ru, CyberLeninka, PubMed, Cochrane Library by keywords. Publications of the original studies results were selected for analysis.
Results. The review summarizes the current research results reflecting the six-minute walk test prognostic value in heart failure patients. The results of large international studies indicate the a relationship existence between the test indicators and the disease clinical outcomes. It has been established that a decrease in the traveled distance is reliably associated with an increased risk of death and the hospitalizations frequency. Particular interest are the data confirming the determining possibility the traveled distance clear prognostic threshold values. These data will allow differentiating patients with different risk levels and can serve as an important guideline for making clinical decisions. At the same time, the results comparison of the six-minute walk test with other, new and accurate methods for assessing physical activity, shows the data comparability, which allows using this method for research and clinical purposes.
Conclusion. The six-minute walk test, being a well-studied diagnostic method, does not lose its relevance. The test methodology does not require costs, expensive equipment, participation of narrow specialists, while it is well tolerated by most patients and can be widely used to determine the prognosis, risk of death / hospitalization due to heart failure decompensation. At the same time, modern technologies make it possible to simplify the procedure for its implementation, including remotely from medical institutions.

1. Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nat Rev Cardiol. 2016;13(6):368–378. https://doi.org/10.1038/nrcardio.2016.25.

2. Li T, Jiang Y-L, Kang J, Song S, Du Q-F, Yi X-D. Prevalence and risk factors of frailty in older patients with chronic heart failure: a systematic review and meta-analysis. Aging Clin Exp Res. 2023;35(12):2861–2871. https://doi.org/10.1007/s40520-023-02587-5.

3. Obokata M, Sorimachi H, Harada T, Kagami K, Saito Y, Ishii H. Epidemiology, Pathophysiology, Diagnosis, and Therapy of Heart Failure With Preserved Ejection Fraction in Japan. J Card Fail. 2023;29(3):375–388. https://doi.org/10.1016/j.cardfail.2022.09.018.

4. Savina AA, Feyginova SI. Dynamics in incidence of diseases of the circulatory system among adults in the Russian Federation in 2007–2019. Social Aspects of Population Health. 2021;67(2):1. (In Russ.) https://doi.org/10.21045/2071-5021-2021-67-2-1.

5. Budreviciute A, Damiati S, Sabir DK, Onder K, Schuller-Goetzburg P, Plakys G et al. Management and Prevention Strategies for Noncommunicable Diseases (NCDs) and Their Risk Factors. Front Public Health. 2020;(8):574111. https://doi.org/10.3389/fpubh.2020.574111.

6. Groenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail. 2020;22(8):1342–1356. https://doi.org/10.1002/ejhf.1858.

7. Smeets M, Vaes B, Mamouris P, Akker MVD, Pottelbergh GV, Goderis G et al. Burden of heart failure in flemish general practices: a registry-based study in the Intego database. BMJ Open. 2019;9(1):e022972. https://doi.org/10.1136/bmjopen-2018-022972.

8. Conrad N, Judge A, Tran J, Mohseni H, Hedgecott D, Crespillo AP et al. Temporal trends and patterns in heart failure incidence: a populationbased study of 4 million individuals. Lancet. 2018;391(10120):572–580. https://doi.org/10.1016/S0140-6736(17)32520-5.

9. McDowell K, Kondo T, Talebi A, Teh K, Bachus E, Boer RA et al. Prognostic Models for Mortality and Morbidity in Heart Failure With Preserved Ejection Fraction. JAMA Cardiol. 2024;9(5):457–465. https://doi.org/10.1001/jamacardio.2024.0284.

10. Agarwala P, Salzman SH. Six-Minute Walk Test: Clinical Role, Technique, Coding, and Reimbursement. Chest. 2020;157(3):603–611. https://doi.org/10.1016/j.chest.2019.10.014.

11. Bohannon RW, Crouch R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract. 2017;23(2):377–381. https://doi.org/10.1111/jep.12629.

12. https://gnicpm.ru/wp-content/uploads/2021/07/sop-pouglublennoj-dispanserizaczii-dlya-uchenogo-soveta-ot-dekabrya-2022.pdf.

13. Galyavich AS, Tereshchenko SN, Uskach TM, Ageev FT, Aronov DM, Arutyunov GP et al. 2024 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2024;29(11):251–349. (In Russ.) https://doi.org/10.15829/1560-4071-2024-6162.

14. Tokmachev RE, Mukhortova MS, Budnevsky AV, Tokmachev EV, Ovsyannikov ES. Comorbidity of chronic heart failure and chronic obstructive pulmonary disease: features of pathogenesis, clinic and diagnostics. Cardiovascular Therapy and Prevention (Russian Federation). 2018;17(6):62–68. (In Russ.) https://doi.org/10.15829/1728-8800-2018-6-62-68.

15. Bubnova MG, Persiyanova-Dubrova AL. Six-minute walk test in cardiac rehabilitation. Cardiovascular Therapy and Prevention (Russian Federation). 2020;19(4):2561. (In Russ.) https://doi.org/10.15829/1728-8800-2020-2561.

16. Budnevsky AV, Kravchenko AYa, Tokmachev RE, Chernik TA, Tokmachev EV, Letnikova YuB. Diagnostic, prognostic and therapeutic potential of 6-minute walk test in patients with chronic heart failure. Cardiovascular Therapy and Prevention (Russian Federation). 2020;9(6):2460. (In Russ.) https://doi.org/10.15829/1728-8800-2020-2460.

17. Grundtvig M, Eriksen‐Volnes T, Orn S, Slind EK, Gullestad L. 6 min walk test is a strong independent predictor of death in outpatients with heart failure. ESC Heart Fail. 2020;7(5):2904–2911. https://doi.org/10.1002/ehf2.12900.

18. Ferreira JP, Metra M, Anker SD, Dickstein K, Lang CC, Ng L et al. Clinical correlates and outcome associated with changes in 6-minute walking distance in patients with heart failure: findings from the BIOSTAT-CHF study. Eur J Heart Fail. 2019;21(2):218–226. https://doi.org/10.1002/ejhf.1380.

19. Matsumoto K, Xiao Y, Homma S, Thompson JLP, Buchsbaum R, Ito K et al. Prognostic impact of 6 min walk test distance in patients with systolic heart failure: insights from the WARCEF trial. ESC Heart Fail. 2021;8(2):819–828. https://doi.org/10.1002/ehf2.13068.

20. Astolpho V, Barbosa R, Devens G, Louzada L, Lima P, Sylvestre R et al. Prognostic Value of the Six-Minute Walk Test in Heart Failure. Preprints. 2020;1(3):2020110185. https://doi.org/10.20944/preprints202011.0185.v1.

21. Ingle L, Cleland JG, Clark AL. The relation between repeated 6-minute walk test performance and outcome in patients with chronic heart failure. Ann Phys Rehabil Med. 2014;57(4):244–253. https://doi.org/10.1016/j.rehab.2014.03.004.

22. Mandi DG, Naibe DT, Bamouni J, Yameogo RA, Kambire Y, Kologo KJ et al. Long-Term Re-Admission after Hospital Discharge in Patients Admitted with Acute Heart Failure: The Prognostic Value of the Six-Minute Walk Test Distance. Open Acc Lib J. 2018;5:e4841. https://doi.org/10.4236/oalib.1104841.

23. Ingle L, Cleland JG, Clark AL. The long-term prognostic significance of 6-minute walk test distance in patients with chronic heart failure. Biomed Res Int. 2014;2014:505969. https://doi.org/10.1155/2014/505969.

24. Tabata M, Shimizu R, Kamekawa D, Kato M, Kamiya K, Akiyama A et al. SixMinute Walk Distance Is an Independent Predictor of Hospital Readmission in Patients with Chronic Heart Failure. Int Heart J. 2014;55(4):331–336. https://doi.org/10.1536/ihj.13-224.

25. Mappangara I, Kabo P, Muzakkir A, Zaenab D, Melda W, Asni M. Six-minute walking test distance predicts readmission in hospitalized heart failure patient in integrated cardiac centre, Makassar, Indonesia. Int J Res Med Sci. 2020;8(12):4360–4364. https://doi.org/10.18203/2320-6012.ijrms20205305.

26. McCabe N, Butler J, Dunbar SB, Higgins M, Reilly C. Six-minute walk distance predicts 30-day readmission after acute heart failure hospitalization. Heart Lung. 2017;46(4):287–292. https://doi.org/10.1016/j.hrtlng.2017.04.001.

27. Wegrzynowska-Teodorczyk K, Rudzinska E, Lazorczyk M, Nowakowska K, Banasiak W, Ponikowski P et al. Distance covered during a six-minute walk test predicts long-term cardiovascular mortality and hospitalisation rates in men with systolic heart failure: an observational study. J Physiother. 2013;59(3):177–187. https://doi.org/10.1016/S1836-9553(13)70182-6.

28. Alahdab MT, Mansour IN, Napan S, Stamos TD. Six-Minute Walk Test Predicts Long-Term All-Cause Mortality and Heart Failure Rehospitalization in African-American Patients Hospitalized With Acute Decompensated Heart Failure. J Card Fail. 2009;15(2):130–135. https://doi.org/10.1016/j.cardfail.2008.10.006.

29. Kommuri VA, Johnson ML, Koelling TM. Six-minute Walk Distance Predicts 30-Day Readmission in Hospitalized Heart Failure Patients. Arch Med Res. 2010;41(5):363–368. https://doi.org/10.1016/j.arcmed.2010.07.005.

30. Forman DE, Fleg JL, Kitzman DW, Brawner CA, Swank AM, McKelvie RS et al. 6-min walk test provides prognostic utility comparable to cardiopulmonary exercise testing in ambulatory outpatients with systolic heart failure. J Am Coll Cardiol. 2012;60(25):2653–2661. https://doi.org/10.1016/j.jacc.2012.08.1010.

31. Prescher S, Schoebel C, Koehler K, Deckwart O, Wellge B, Honold M et al. Prognostic value of serial six-minute walk tests using tele-accelerometry in patients with chronic heart failure: A pre-specified sub-study of the TIM-HF-Trial. Eur J Prev Cardiol. 2016;23(2):21–26. https://doi.org/10.1177/2047487316671438.