Prolonged heart rate recovery time after 6-minute walk test is an independent risk factor for cardiac events in heart failure: A prospective cohort study

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Andrade, G. N. ; Rodrigues, T. ; Takada, J. Y. ; Braga, L. M. ; Umeda, I. I. K. ; Nascimento, J. A. ; Pereira-Filho, H. G. ; Grupi, C. J. ; Salemi, V. M. C. ; Jacob-Filho, W. ; Cahalin, L. P. ; Mansur, A. P. ; Bocchi, E. A. ; Nakagawa, N. K.

• Document type: Journal article
• Source: PHYSIOTHERAPY; v. 114, p. 8-pg., 2022-03-01.

Abstract

Objectives To determine whether the time for peak exercise heart rate to return to resting heart rate after the 6-minute walk test (6MWT) can predict cardiac events in patients with heart failure (HF) within 2 years. Design Prospective cohort study. Setting HF outpatient facility at a tertiary teaching hospital. Participants Seventy-six patients with HF, New York Heart Association functional classification II and III, and left ventricular ejection fraction < 50%. Main outcome measures Patients used a heart rate monitor to measure the time for peak exercise heart rate to return to resting heart rate after the 6MWT. Data were analysed using Polar Pro-Trainer 5 software (Kempele, Finland). Patients were followed for > 2 years for cardiac events (hospitalisations and death). Results Thirty-four patients had cardiac events during the 2-year follow-up period. However, there was a significant difference in the time to return to resting heart rate between the groups with and without cardiac events {with 3.6 (SD 1.1) vs without 2.8 (SD 1.1) minutes; mean difference of 0.79 (95% confidence interval (CI) of the difference 0.28 to 1.28; P = 0.003}. No significant differences between patients with and without cardiac events were found for mean walking distance, mean heart rate recovery at 1 minute and mean heart rate recovery at 2 minutes. The receiver operating curve discriminated between patients with and without cardiac events (area under the curve 0.71, 95% CI 0.61 to 0.81; P < 0.001). Using logistic regression analysis, prolonged time to return to resting heart rate (>= 3 minutes) independently increased the risk for cardiac events 6.9-fold (95% CI 2.34 to 20.12; P < 0.001). The Kaplan-Meier curve showed more cardiac events in patients with prolonged time to return to resting heart rate (P = 0.028). Conclusions Prolonged time to return to resting heart rate (>= 3 minutes) after the 6MWT was an independent predictor of cardiac events in patients with HF. (c) 2021 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved. (AU)

• FAPESP's process: 19/02880-4 - World Confederation Physical Therapy
• Grantee: Naomi Kondo Nakagawa
• Support Opportunities: Research Grants - Meeting - Abroad
• FAPESP's process: 17/21264-7 - Predictors of inspiratory muscle weakness in patients with heart failure: clinical parameters, functional capacity and inflammatory and cardiovascular diseases biomarkers
• Grantee: Naomi Kondo Nakagawa
• Support Opportunities: Regular Research Grants
• FAPESP's process: 13/13598-1 - Physiotherapy: functionality and biomolecular and cellular study in the treatment of patients with cardiorespiratory dysfunctions
• Grantee: Naomi Kondo Nakagawa
• Support Opportunities: Regular Research Grants