The 6‐Minute Walk Is Associated With Frailty and Predicts Mortality in Older Adults With Heart Failure

Boxer, Rebecca S.; Kleppinger, Alison; Ahmad, A.; Annis, Kristin; Hager, David; Kenny, Anne M.

doi:10.1111/j.1751-7133.2010.00151.x

Cited by 119 publications

(94 citation statements)

References 39 publications

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“…21 The 6MW distance has demonstrated prognostic value in other clinical populations, including patients with chronic obstructive pulmonary disease or heart failure, older adults and those with solid tumors, hematological malignancies and post-transplant survivors. [28][29][30] Cardiopulmonary exercise testing has demonstrated predictive ability in advanced lung and breast cancer. 12,13 Functional capacity impairments in patients with chronic GVHD have also been shown to mediate adverse changes in post-HCT functional performance associated with symptom burden.…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary fitness in patients undergoing hematopoietic SCT: a pilot study

Wood

Deal

Reeve

et al. 2013

Bone Marrow Transplant

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Hematopoietic cell transplantation (HCT) is a life-saving treatment for patients with high-risk hematological malignancies. Prognostic measures to determine fitness for HCT are needed to inform decision-making and interventions. VO 2peak is obtained by measuring gas exchange during cycle ergometry and has not been studied as a prognostic factor in HCT. Thirty-two autologous and allogeneic HCT patients underwent VO 2peak and 6 Minute Walk (6MW) testing before HCT, and provided weekly symptom and health-related quality of life (HRQOL) assessments before HCT and concluding at Day 100. Twenty-nine patients completed pre-HCT testing. Pre-HCT VO 2peak was positively correlated with pre-HCT 6MW (r ¼ 0.65, Po0.001) and negatively correlated with number of chemotherapy regimens and months of chemotherapy. Patients with lower VO 2peak reported higher symptom burden and inferior HRQOL at baseline and during early post-HCT period. Patients with pre-HCT VO 2peak o16 mL/kg/min had higher risk of mortality post HCT (entire cohort: hazard ratio (HR) 9.1 (1.75-47.0), P ¼ 0.01; allogeneic HCT patients only: HR 6.70 (1.29-34.75), P ¼ 0.02) and more hospitalized days before Day 100 (entire cohort: median 33 vs 19, P ¼ 0.003; allogeneic HCT patients only: median 33 vs 21, P ¼ 0.004). VO 2peak pre-HCT is feasible and might predict symptom severity, HRQOL and mortality. Additional studies are warranted. Keywords: cardiopulmonary fitness; symptoms; health-related quality of life; hematopoietic SCT INTRODUCTIONFor patients with life-threatening hematological diseases, hematopoietic cell transplantation (HCT) offers the possibility of extended survival relative to standard conventional treatments. 1 The benefits of HCT are counterbalanced by the risk of treatmentrelated toxicity. Prognostic measures are needed to inform clinician and patient decision-making and to limit treatmentrelated risk. Direct cardiopulmonary fitness assessments such as VO 2peak are now available but have not yet been studied.Myeloablative allogeneic HCT has been associated with a 30-40% risk of treatment-related mortality (TRM). 2 Reduced intensity conditioning HCT is offered to older individuals and patients with comorbid illness, but this technique is still associated with a 20-30% risk of TRM. 3 Autologous HCT in older patients has been associated with a TRM risk exceeding 10%. 4 Subsets of patients after all types of transplants experience late health-related quality of life (HRQOL) deficits and functional impairment; 5 this effect is variable with other subgroups experiencing preserved patient-reported outcomes (PROs), relative to normative values. 6 Investigators and clinicians have attempted to determine who is 'fit' for transplant to inform pre-HCT counseling, selection of suitable HCT candidates and identification of vulnerable HCT recipients at risk for treatment-related complications. 7 Age remains the most commonly used surrogate variable for HCT

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Section: Discussionmentioning

confidence: 99%

Cardiopulmonary fitness in patients undergoing hematopoietic SCT: a pilot study

Wood

Deal

Reeve

et al. 2013

Bone Marrow Transplant

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“…[50][51][52][53][54][55][56] Performance on a 6-minute walk test is strongly and inversely related to frailty. 57 The 6-minute walk test and similar walking tests are associated with multiple domains of physical function and outcomes in the elderly and patients with CVD. [57][58][59][60] These results strongly suggest that in addition to improved survival, higher CRF is related to better health and physical function in elderly individuals.…”

Section: Importance Of Crfmentioning

confidence: 99%

“…57 The 6-minute walk test and similar walking tests are associated with multiple domains of physical function and outcomes in the elderly and patients with CVD. [57][58][59][60] These results strongly suggest that in addition to improved survival, higher CRF is related to better health and physical function in elderly individuals. In addition to enhanced CRF, improving functional status and attenuating frailty are important objectives for the application of exercise therapy.…”

Section: Importance Of Crfmentioning

confidence: 99%

The Importance of Cardiorespiratory Fitness in the United States: The Need for a National Registry

Kaminsky¹,

Arena

Beckie³

et al. 2013

Circulation

320

214

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“…39,40 Frailty also confounds patient assessment and tolerance of medical therapies and increases mortality. 41,42 …”

Section: Table 1 Classification Of Recommendations and Level Of Evidmentioning

confidence: 99%

Heart Failure Management in Skilled Nursing Facilities

Jurgens¹,

Goodlin²,

Dolansky³

et al. 2015

Circ: Heart Failure

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655H eart failure (HF) is a complex syndrome in which structural or functional cardiac abnormalities impair the filling of ventricles or left ventricular ejection of blood. HF disproportionately occurs in those ≥65 years of age.1 Among the estimated 1.5 to 2 million residents in skilled nursing facilities (SNFs) in the United States, cardiovascular disease is the largest diagnostic category, and HF is common. 2,3Despite the high prevalence of HF in SNF residents, none of the large randomized clinical trials of HF therapy included SNF residents, and very few included patients >80 years of age with complex comorbidities.Several issues make it important to address HF care in SNFs. The healthcare environment and characteristics of SNF residents are distinct from those of community-dwelling adults. Comorbid illness unrelated to HF (eg, dementia, hip fracture) increases with age >75 years, and these conditions may complicate both the initial HF diagnosis and ongoing management. [4][5][6] Morbidity and mortality rates are significantly increased for hospitalized older adults with HF discharged to SNFs compared with those discharged to other sites. 7Transitions between hospitals and SNFs may be problematic. 8SNF 30-day rehospitalization rates for HF range from 27% to 43%, 7,9,10 and long-term care residents sent to the emergency department are at increased risk for hospital admission and death.11 The purpose of this scientific statement is to provide guidance for management of HF in SNFs to improve patientcentered outcomes and reduce hospitalizations. This statement addresses unique issues of SNF care and adapts HF guidelines and other recommendations to this setting. MethodsThis scientific statement on HF management in SNFs was developed by a writing group of experts representing nursing, medicine (cardiology, geriatrics, nursing home physicians, and palliative medicine), pharmacology, physical therapy, dietary clinical management, research, and quality of care. Sponsors (the American Heart Association [AHA] and the Heart Failure Society of America) identified specific members of the writing group, and others were selected on the basis of known expertise. A literature search was performed using the key The current document is solely the responsibility of the authors and does not represent the official views of the National Heart, Lung, and Blood Institute or the Department of Health and Human Services.The American Heart Association and the Heart Failure Society of America make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This document was approved by the American Heart Association Science Advisory and Coordinating Committee on September 15, 2014, and by the...

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The 6‐Minute Walk Is Associated With Frailty and Predicts Mortality in Older Adults With Heart Failure

Cited by 119 publications

References 39 publications

Cardiopulmonary fitness in patients undergoing hematopoietic SCT: a pilot study

Cardiopulmonary fitness in patients undergoing hematopoietic SCT: a pilot study

The Importance of Cardiorespiratory Fitness in the United States: The Need for a National Registry

Heart Failure Management in Skilled Nursing Facilities

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