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Published in: Clinical Research in Cardiology 8/2021

01-08-2021 | Nebivolol | Original Paper

Six-minute walk test: prognostic value and effects of nebivolol versus placebo in elderly patients with heart failure from the SENIORS trial

Authors: Marcelo C. Shibata, Jordan Curl-Roper, Dirk J. Van Veldhuisen, Michael Roughton, Andrew J. S. Coats, Marcus Flather

Published in: Clinical Research in Cardiology | Issue 8/2021

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Abstract

Background

There is limited information about the 6-min walk test (6MWT) in elderly patients with heart failure. We evaluated 6MWT and the effect of nebivolol on 6MWT from the SENIORS trial.

Methods and results

The SENIORS trial evaluated nebivolol versus placebo on death and hospitalisation in patients aged ≥ 70 years with heart failure. A total of 1982 patients undertook a 6MWT at baseline and 1716 patients at 6 months. Patients were divided into tertiles (≤ 200 m, 201 to ≤ 300 m and > 300 m) and to change in distance walked between baseline and 6 months (< 0 m, 0 to < 30 m and ≥ 30 m). The primary outcome was all-cause mortality and cardiovascular hospital admission. Secondary endpoint was all-cause mortality. Baseline walk distance of ≤ 200 m incurred a greater risk of the primary and secondary outcomes (HR 1.41, CI 95% 1.17–1.69, p < 0.001) and (HR 1.37, CI 95% 1.05–1.78, p = 0.019). A decline in walk distance over 6 months was associated with increased risk of clinical events. Nebivolol had no influence on change in walk distance over 6 months.

Conclusions

The 6MWT has prognostic utility in elderly patients. Those who walked less than 200 m were at highest risk. Nebivolol had no effect on 6MWT.
Literature
1.
go back to reference Guha K, McDonagh T (2013) Heart failure epidemiology: European perspective. Curr Cardiol Rev 9(2):123–127CrossRef Guha K, McDonagh T (2013) Heart failure epidemiology: European perspective. Curr Cardiol Rev 9(2):123–127CrossRef
2.
go back to reference Adams KF, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, Berkowitz RL, Galvao M, Horton DP, ADHERE Scientific Advisory Committee and Investigators (2005) Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 149(2):209–216CrossRef Adams KF, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, Berkowitz RL, Galvao M, Horton DP, ADHERE Scientific Advisory Committee and Investigators (2005) Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 149(2):209–216CrossRef
4.
go back to reference Ingle L, Cleland JG, Clark AL (2014b) The relation between repeated 6-minute walk test performance and outcome in patients with chronic heart failure. Ann Phys Rehabil Med 57(4):244–253CrossRef Ingle L, Cleland JG, Clark AL (2014b) The relation between repeated 6-minute walk test performance and outcome in patients with chronic heart failure. Ann Phys Rehabil Med 57(4):244–253CrossRef
5.
go back to reference Forman DE, Fleg JL, Kitzman DW, Brawner CA, Swank AM, McKelvie RS, Clare RM, Ellis SJ, Dunlap ME, Bittner V (2012) 6-min walk test provides prognostic utility comparable to cardiopulmonary exercise testing in ambulatory outpatients with systolic heart failure. J Am Coll Cardiol 60(25):2653–2661CrossRef Forman DE, Fleg JL, Kitzman DW, Brawner CA, Swank AM, McKelvie RS, Clare RM, Ellis SJ, Dunlap ME, Bittner V (2012) 6-min walk test provides prognostic utility comparable to cardiopulmonary exercise testing in ambulatory outpatients with systolic heart failure. J Am Coll Cardiol 60(25):2653–2661CrossRef
6.
go back to reference Cowie MR, Wood DA, Coats AJ, Thompson SG, Poole-Wilson PA, Suresh V, Sutton GC (1999) Incidence and aetiology of heart failure; a population-based study. Eur Heart J 20(6):421–428CrossRef Cowie MR, Wood DA, Coats AJ, Thompson SG, Poole-Wilson PA, Suresh V, Sutton GC (1999) Incidence and aetiology of heart failure; a population-based study. Eur Heart J 20(6):421–428CrossRef
7.
go back to reference Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. New Eng J Med 355(3):251–259CrossRef Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. New Eng J Med 355(3):251–259CrossRef
8.
go back to reference Olsson LG, Swedberg K, Clark AL, Witte KK, Cleland JG (2005) Six minute corridor walk test as an outcome measure for the assessment of treatment in randomized, blinded intervention trials of chronic heart failure: a systematic review. Eur Heart J 26(8):778–793CrossRef Olsson LG, Swedberg K, Clark AL, Witte KK, Cleland JG (2005) Six minute corridor walk test as an outcome measure for the assessment of treatment in randomized, blinded intervention trials of chronic heart failure: a systematic review. Eur Heart J 26(8):778–793CrossRef
9.
go back to reference Conraads VM, Metra M, Kamp O, De Keulenaer GW, Pieske B, Zamorano J, Vardas PE, Böhm M, Dei Cas L (2012) Effects of the long-term administration of nebivolol on the clinical symptoms, exercise capacity, and left ventricular function of patients with diastolic dysfunction: results of the ELANDD study. Eur J Heart Fail 14(2):219–225CrossRef Conraads VM, Metra M, Kamp O, De Keulenaer GW, Pieske B, Zamorano J, Vardas PE, Böhm M, Dei Cas L (2012) Effects of the long-term administration of nebivolol on the clinical symptoms, exercise capacity, and left ventricular function of patients with diastolic dysfunction: results of the ELANDD study. Eur J Heart Fail 14(2):219–225CrossRef
10.
go back to reference Flather MD, Shibata MC, Coats AJ, Van Veldhuisen DJ, Parkhomenko A, Borbola J, Cohen-Solal A, Dumitrascu D, Ferrari R, Lechat P, Soler-Soler J, Tavazzi L, Spinarova L, Toman J, Böhm M, Anker SD, Thompson SG, Poole-Wilson PA, SENIORS Investigators (2005) Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 26:215–225CrossRef Flather MD, Shibata MC, Coats AJ, Van Veldhuisen DJ, Parkhomenko A, Borbola J, Cohen-Solal A, Dumitrascu D, Ferrari R, Lechat P, Soler-Soler J, Tavazzi L, Spinarova L, Toman J, Böhm M, Anker SD, Thompson SG, Poole-Wilson PA, SENIORS Investigators (2005) Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 26:215–225CrossRef
11.
go back to reference Cohen-Solal A, Kotecha D, van Veldhuisen DJ, Babalis D, Böhm M, Coats AJ, Roughton M, Poole-Wilson P, Tavazzi L, Flather M, SENIORS Investigators (2009) Efficacy and safety of nebivolol in elderly heart failure patients with impaired renal function: insights from the SENIORS trial. Eur J Heart Fail 11:872–880CrossRef Cohen-Solal A, Kotecha D, van Veldhuisen DJ, Babalis D, Böhm M, Coats AJ, Roughton M, Poole-Wilson P, Tavazzi L, Flather M, SENIORS Investigators (2009) Efficacy and safety of nebivolol in elderly heart failure patients with impaired renal function: insights from the SENIORS trial. Eur J Heart Fail 11:872–880CrossRef
12.
go back to reference van Veldhuisen DJ, Cohen-Solal A, Böhm M, Anker SD, Babalis D, Roughton M, Coats AJ, Poole-Wilson PA, Flather MD, on behalf of the SENIORS Investigators (2009) Beta-blockade with nebivolol in elderly heart failure patients with impaired and preserved left ventricular ejection fraction. J Am Coll Cardiol 53:2150–2158CrossRef van Veldhuisen DJ, Cohen-Solal A, Böhm M, Anker SD, Babalis D, Roughton M, Coats AJ, Poole-Wilson PA, Flather MD, on behalf of the SENIORS Investigators (2009) Beta-blockade with nebivolol in elderly heart failure patients with impaired and preserved left ventricular ejection fraction. J Am Coll Cardiol 53:2150–2158CrossRef
13.
go back to reference ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166(1):111CrossRef ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166(1):111CrossRef
14.
go back to reference Manzano L, Babalis D, Roughton M, Shibata M, Anker SD, Ghio S, Veldhuisen DJ, Cohen-Solal A, Coats AJ, Poole-Wilson P, Flather MD (2011) Predictors of clinical outcomes in elderly patients with heart failure. Eur J Heart Fail 13(5):528–536CrossRef Manzano L, Babalis D, Roughton M, Shibata M, Anker SD, Ghio S, Veldhuisen DJ, Cohen-Solal A, Coats AJ, Poole-Wilson P, Flather MD (2011) Predictors of clinical outcomes in elderly patients with heart failure. Eur J Heart Fail 13(5):528–536CrossRef
15.
go back to reference Rubim VS, Drumond Neto C, Romeo JL, Montera MW (2006) Prognostic value of the six-minute walk test in heart failure. Arq Bras Cardiol 86(2):120–125CrossRef Rubim VS, Drumond Neto C, Romeo JL, Montera MW (2006) Prognostic value of the six-minute walk test in heart failure. Arq Bras Cardiol 86(2):120–125CrossRef
16.
go back to reference Opasich C, Pinna GD, Mazza A, Febo O, Riccardi R, Riccardi PG, Capomolla S, Forni G, Cobelli F, Tavazzi L (2001) Six-minute walking performance in patients with moderate-to-severe heart failure; is it a useful indicator in clinical practice? Eur Heart J 22(6):488–496CrossRef Opasich C, Pinna GD, Mazza A, Febo O, Riccardi R, Riccardi PG, Capomolla S, Forni G, Cobelli F, Tavazzi L (2001) Six-minute walking performance in patients with moderate-to-severe heart failure; is it a useful indicator in clinical practice? Eur Heart J 22(6):488–496CrossRef
17.
go back to reference Arslan S, Erol MK, Gundogdu F, Sevimli S, Aksakal E, Senocak H, Alp N (2007) Prognostic value of 6-minute walk test in stable outpatients with heart failure. Tex Heart Inst J 34(2):166–169PubMedPubMedCentral Arslan S, Erol MK, Gundogdu F, Sevimli S, Aksakal E, Senocak H, Alp N (2007) Prognostic value of 6-minute walk test in stable outpatients with heart failure. Tex Heart Inst J 34(2):166–169PubMedPubMedCentral
18.
go back to reference Roul G, German P, Bareiss P (1998) Does the 6 minute walk test predict the prognosis in patients with NYHA class II and III heart failure? Am Heart J 136:449–457CrossRef Roul G, German P, Bareiss P (1998) Does the 6 minute walk test predict the prognosis in patients with NYHA class II and III heart failure? Am Heart J 136:449–457CrossRef
19.
go back to reference Reibis RK, Treszl A, Wegscheider K, Ehrlich B, Dissmann R, Völler H (2010) Exercise capacity is the most powerful predictor of 2-year mortality in patients with left ventricular systolic dysfunction. Herz 35(2):104–110CrossRef Reibis RK, Treszl A, Wegscheider K, Ehrlich B, Dissmann R, Völler H (2010) Exercise capacity is the most powerful predictor of 2-year mortality in patients with left ventricular systolic dysfunction. Herz 35(2):104–110CrossRef
20.
go back to reference Wegrzynowska-Teodorczyk K, Rudzinska E, Lazorczyk M, Nowakowska K, Banasiak W, Ponikowski P, Wozniewski M, Jankowska EA (2013) 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 59(3):177–187CrossRef Wegrzynowska-Teodorczyk K, Rudzinska E, Lazorczyk M, Nowakowska K, Banasiak W, Ponikowski P, Wozniewski M, Jankowska EA (2013) 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 59(3):177–187CrossRef
21.
go back to reference Rostagno C, Olivo G, Comeglio M, Boddi V, Banchelli M, Galanti G, Gensini GF (2003) Prognostic value of 6-minute walk corridor test in patients with mild to moderate heart failure: comparison with other methods of functional evaluation. Eur J Heart Fail 5(3):247–252CrossRef Rostagno C, Olivo G, Comeglio M, Boddi V, Banchelli M, Galanti G, Gensini GF (2003) Prognostic value of 6-minute walk corridor test in patients with mild to moderate heart failure: comparison with other methods of functional evaluation. Eur J Heart Fail 5(3):247–252CrossRef
22.
go back to reference Lucas C, Stevenson LW, Johnson W, Hartley H, Hamilton MA, Walden J, Lem V, Eagen-Bengsten E (1999) The 6-min walk and peak oxygen consumption in advanced heart failure: aerobic capacity and survival. Am Heart J 138(4):618–624CrossRef Lucas C, Stevenson LW, Johnson W, Hartley H, Hamilton MA, Walden J, Lem V, Eagen-Bengsten E (1999) The 6-min walk and peak oxygen consumption in advanced heart failure: aerobic capacity and survival. Am Heart J 138(4):618–624CrossRef
23.
go back to reference Ingle L, Rigby AS, Carroll S, Butterly R, King RF, Cooke CB, Cleland JG, Clark AL (2007) Prognostic value of the 6 min walk test and self-perceived symptom severity in older patients with chronic heart failure. Eur Heart J 28:560–568CrossRef Ingle L, Rigby AS, Carroll S, Butterly R, King RF, Cooke CB, Cleland JG, Clark AL (2007) Prognostic value of the 6 min walk test and self-perceived symptom severity in older patients with chronic heart failure. Eur Heart J 28:560–568CrossRef
24.
go back to reference Grewal J, McCully RB, Kane GC, Lam C, Pellikka PA (2009) Left ventricular function and exercise capacity. JAMA 301(3):286–294CrossRef Grewal J, McCully RB, Kane GC, Lam C, Pellikka PA (2009) Left ventricular function and exercise capacity. JAMA 301(3):286–294CrossRef
25.
go back to reference Fontes-Carvalho R, Sampaio F, Teixeira M, Rocha-Gonçalves F, Gama V, Azevedo A, Leite-Moreira A (2015) Left ventricular diastolic dysfunction and E/E′ ratio as the strongest echocardiographic predictors of reduced exercise capacity after acute myocardial infarction. Clin Cardiol 38(4):222–229CrossRef Fontes-Carvalho R, Sampaio F, Teixeira M, Rocha-Gonçalves F, Gama V, Azevedo A, Leite-Moreira A (2015) Left ventricular diastolic dysfunction and E/E′ ratio as the strongest echocardiographic predictors of reduced exercise capacity after acute myocardial infarction. Clin Cardiol 38(4):222–229CrossRef
26.
go back to reference Wenger NK (1988) Left ventricular dysfunction, exercise capacity and activity recommendations. Eur Heart J 9(suppl F):63–66CrossRef Wenger NK (1988) Left ventricular dysfunction, exercise capacity and activity recommendations. Eur Heart J 9(suppl F):63–66CrossRef
27.
go back to reference Guazzi M, Dickstein K, Vicenzi M, Ross A (2009) Six-minute walk test and cardiopulmonary exercise testing in patients with chronic heart failure: a comparative analysis on clinical and prognostic insights. Circ Heart Fail 2:549–555CrossRef Guazzi M, Dickstein K, Vicenzi M, Ross A (2009) Six-minute walk test and cardiopulmonary exercise testing in patients with chronic heart failure: a comparative analysis on clinical and prognostic insights. Circ Heart Fail 2:549–555CrossRef
28.
go back to reference Ferreira JP, Metra M, Anker SD, Dickstein K, Lang CC, Samani NJ et al (2019) Clinical correlates and outcome associated with changes in 6-minute walk distance in patients with heart failure: findings from the BIOSTAT-CHF study. Eur J Heart Fail 21:218–226CrossRef Ferreira JP, Metra M, Anker SD, Dickstein K, Lang CC, Samani NJ et al (2019) Clinical correlates and outcome associated with changes in 6-minute walk distance in patients with heart failure: findings from the BIOSTAT-CHF study. Eur J Heart Fail 21:218–226CrossRef
29.
go back to reference Enright PL, McBurnie MA, Bittner V, Tracy RP, McNamara R, Arnold A, Newman AB (2003) The 6-min walk test: a quick measure of functional status in elderly adults. Chest 123(2):387–398CrossRef Enright PL, McBurnie MA, Bittner V, Tracy RP, McNamara R, Arnold A, Newman AB (2003) The 6-min walk test: a quick measure of functional status in elderly adults. Chest 123(2):387–398CrossRef
30.
go back to reference Passantino A, Lagioia R, Mastropasqua F, Scrutinio D (2006) Short-term change in distance walked in 6 min is an indicator of outcome in patients with chronic heart failure in clinical practice. J Am Coll Cardiol 48(1):99–105CrossRef Passantino A, Lagioia R, Mastropasqua F, Scrutinio D (2006) Short-term change in distance walked in 6 min is an indicator of outcome in patients with chronic heart failure in clinical practice. J Am Coll Cardiol 48(1):99–105CrossRef
31.
go back to reference Shah MR, Hasselblad V, Gheorghiade M, Adams KF, Swedberg K, Califf RM, O’Connor CM (2001) Prognostic usefulness of the six-minute walk in patients with advanced congestive heart failure secondary to ischemic or non-ischemic cardiomyopathy. Am J Cardiol 88(9):987–993CrossRef Shah MR, Hasselblad V, Gheorghiade M, Adams KF, Swedberg K, Califf RM, O’Connor CM (2001) Prognostic usefulness of the six-minute walk in patients with advanced congestive heart failure secondary to ischemic or non-ischemic cardiomyopathy. Am J Cardiol 88(9):987–993CrossRef
32.
go back to reference Linssen GCM, Veenis JF, Kleberger A, Grosfield MJW, Viergever EP, van Dalen BM, de Valk-Bedijin W, Langerveld J, Brunner-La Rocca HP, Hoes AW, Brugts JJ (2020) Medical treatment of octogenarians with chronic heart failure: data from CHECK-HF. Clin Res Cardiol. https://doi.org/10.1007/s00392-020-01607-y ((Epub ahead of print, PMID: 32030498))CrossRefPubMed Linssen GCM, Veenis JF, Kleberger A, Grosfield MJW, Viergever EP, van Dalen BM, de Valk-Bedijin W, Langerveld J, Brunner-La Rocca HP, Hoes AW, Brugts JJ (2020) Medical treatment of octogenarians with chronic heart failure: data from CHECK-HF. Clin Res Cardiol. https://​doi.​org/​10.​1007/​s00392-020-01607-y ((Epub ahead of print, PMID: 32030498))CrossRefPubMed
33.
go back to reference Bekfani T, Pellicori P, Morris D, Ebner N, Valentova M, Sandek A, Doehner W, Cleland JG, Lainscak M, Shulze PC, Anker SD, von Haehling S (2019) Iron deficiency in patients with heart failure with preserved ejection fraction and its association with reduced exercise capacity, muscle strength and quality of life. Clin Res Cardiol 108:203–211CrossRef Bekfani T, Pellicori P, Morris D, Ebner N, Valentova M, Sandek A, Doehner W, Cleland JG, Lainscak M, Shulze PC, Anker SD, von Haehling S (2019) Iron deficiency in patients with heart failure with preserved ejection fraction and its association with reduced exercise capacity, muscle strength and quality of life. Clin Res Cardiol 108:203–211CrossRef
34.
go back to reference Radenovic S, Loncar G, Busjahn A, Apostolovic S, Zdravkovic M, Karlicic V, Veskovic J, Tahirovic E, Butler J, Düngen HD (2018) Systemic inflammation and functional capacity in elderly heart failure patients. Clin Res Cardiol 107:362–367CrossRef Radenovic S, Loncar G, Busjahn A, Apostolovic S, Zdravkovic M, Karlicic V, Veskovic J, Tahirovic E, Butler J, Düngen HD (2018) Systemic inflammation and functional capacity in elderly heart failure patients. Clin Res Cardiol 107:362–367CrossRef
Metadata
Title
Six-minute walk test: prognostic value and effects of nebivolol versus placebo in elderly patients with heart failure from the SENIORS trial
Authors
Marcelo C. Shibata
Jordan Curl-Roper
Dirk J. Van Veldhuisen
Michael Roughton
Andrew J. S. Coats
Marcus Flather
Publication date
01-08-2021
Publisher
Springer Berlin Heidelberg
Published in
Clinical Research in Cardiology / Issue 8/2021
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-020-01768-w

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