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Increase in 6-minute walk distance during hospitalization predicts the readmission due to decompensated heart failure in patients with chronic heart failure

Session Prognosis and cost-effectiveness of cardiac rehabilitation

Speaker Associate Professor Minoru Tabata

Event : ESC Congress 2016

  • Topic : preventive cardiology
  • Sub-topic : Outcomes
  • Session type : Moderated Posters

Authors : M Tabata (Toyohashi,JP), T Masuda (Sagamihara,JP), M Kato (Sagamihara,JP), R Shimizu (Sagamihara,JP), A Akiyama (Sagamihara,JP), Y Kamada (Sagamihara,JP), S Tanaka (Sagamihara,JP), N Hamazaki (Sagamihara,JP), A Aoyama (Sagamihara,JP), K Kamiya (Sagamihara,JP)

Authors:
M. Tabata1 , T. Masuda2 , M. Kato2 , R. Shimizu2 , A. Akiyama2 , Y. Kamada2 , S. Tanaka2 , N. Hamazaki2 , A. Aoyama2 , K. Kamiya3 , 1Toyohashi SOZO University, School of Health Sciences - Toyohashi - Japan , 2Kitasato University, Graduate School of Medical Sciences - Sagamihara - Japan , 3Kitasato University Hospital, Rehabilitation Center - Sagamihara - Japan ,

Topic(s):
Cardiovascular rehabilitation: interventions and outcomes

Citation:
European Heart Journal ( 2016 ) 37 ( Abstract Supplement ), 621-622

Background: Patients with chronic heart failure (CHF) are frequently readmitted to the hospital. Six-minute walk distance (6MWD) is a clinical measure to assess patients' exercise capacity and prognosis. However, few reports documented the correlations of 6MWD increase during hospitalization with exercise capacity and prognosis.

Purpose: This study aimed to investigate whether the 6MWD increase during hospitalization predicted the readmission due to decompensated CHF in patients with CHF.

Methods: Patients who were hospitalized due to CHF with New York Heart Association (NYHA) Functional Classification III or IV were prospectively followed up for 2 years after hospital discharge. We assessed clinical characteristics including age, gender, height, NYHA functional classification, etiology of CHF, plasma brain natriuretic peptide and left ventricular ejection fraction (LVEF) on admission, and measured their 6MWD several days after admission and at discharge. Consequently, we studied 159 patients aged 67.0±11.7 years (114 males and 45 females). We determined significant factors affecting the readmission and their cut-off values using univariate and multivariate logistic regression analyses and the area under the receiver operating characteristics curves (AUC).

Results: Of 159 CHF patients, 77 were readmitted within 2 years after hospital discharge. Univariate logistic regression analysis detected the age, LVEF, 6MWD increase during hospitalization and 6MWD at discharge as significant limiting factors for readmission (P<0.01, respectively). Multivariate logistic regression analysis detected the 6MWD increase during hospitalization and 6MWD at discharge as significant limiting factors for readmission (P<0.001 and P<0.01, respectively). The odds ratios of readmission were 2.2 (95% confidence interval [CI]: 1.6 - 2.9, P<0.001) with each 10-meter decrease of 6MWD increase during hospitalization, and 1.2 (95% CI: 1.1 - 1.3, P<0.01) with each 10-meter decrease of 6MWD at discharge. The AUC for 6MWD increase during hospitalization and its predictive cut-off value were 0.88 and 50 meters, respectively (Figure). The AUC for 6MWD at discharge and its predictive cut-off value were 0.77 and 390 meters, respectively (Figure). When CHF patients showed 50 meters or less in the 6MWD increase during hospitalization, the diagnostic odds ratio and relative risk for readmission were 17.6 (95% CI: 7.5 - 41.1, P<0.001) and 2.7 (95% CI: 2.1 - 3.3, P<0.001), respectively. When they showed 390 meters or less in the 6MWD at discharge, the diagnostic odds ratio and relative risk for readmission were 4.8 (95% CI: 2.4 - 9.7, P<0.001) and 2.7 (95% CI: 1.7 - 4.3, P<0.001), respectively.

Conclusion: The 6MWD increase during hospitalization was shown as a strong predictor for readmission due to decompensated CHF and its predictive cut-off value was 50 meters in CHF patients.

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