Mortality in Patients with Heart Failure With Recovered Ejection Fraction - Outcomes From an Urban Teaching Medical Center.

Abstract

Introduction: With a 30-day all cause readmission rate around 23%, individuals with heart failure (HF) are a medically high risk and costly patient population. Though predictive models have been developed for readmission based on descriptive variables, many of these tools are cumbersome and limited in prognosticative capacity. A few studies have examined the role of the six-minute walk test (6MWT) and found good predictive ability for both 30-day and 1-3-year readmission rates. The goal of this study was to further elucidate the prognostic ability of the 6MWT in stage C/D HF patients with NYHA class IIIb-VI symptoms. Methods: We prospectively enrolled 97 patients who from our step-down units with a primary diagnosis of heart failure between October 2016 and March 2017. Every patient who was enrolled had a standardized 6MWT prior to discharge. Multivariate logistic regression analysis was constructed to determine relationships between 6MW distance and 30-day survival free of readmission. Results: Baseline characteristics were compared between the 6minute walk test distance groups using Wilcoxon rank-sum tests for continuous variables and Fisher's exact tests for categorical variables, and no significant differences were found between the patients. The 135-meter cut-point was selected as the threshold which maximizes the sum of sensitivity and specificity of a logistic regression model for 30-day readmission with 6-minute walk test distance as a continuous predictor. Approximately 25.7% of the patients walked less than 135 meters. Out of these about 32% were admitted within 30 days [p= .026]. Among the patients who walked > 135 meters, 11.1% were admitted within 30 days [p= 0.026]. Furthermore, patients who walked <135m, also had higher frequency of annual re-admissions (36% vs. 12.5%) compared to patients who walked more than 135 meters. Conclusions: 6MWT distance less than 135m was associated with not only increased risk of 30 day readmission but also correlated with increased frequency of admissions in patients admitted with stage C/D heart failure. Figure 1. Probability of all-cause death.