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Vera Bittner, MD; Debra H. Weiner, MPH; Salim Yusuf, MBBS, DPhil; William J. Rogers, MD; Kevin M. McIntyre, MD; Shrikant I. Bangdiwala, PhD; Marvin W. Kronenberg, MD; John B. Kostis, MD; Robert M. Kohn, MD; Maureen Guillotte, RN; Barry Greenberg, MD; Patricia A. Woods, RN; Martial G. Bourassa, MD; the SOLVD Investigators

JAMA. 1993;270(14):1702-1707.

Abstract
Objective.
—To study the potential usefulness of the 6-minute walk test, a self-paced submaximal exercise test, as a prognostic indicator in patients with left ventricular dysfunction.

Design.
—Data were collected during a prospective cohort study, the Studies of Left Ventricular Dysfunction (SOLVD) Registry Substudy.

Setting.
—Twenty tertiary care hospitals in the United States, Canada, and Belgium.

Participants.
—A stratified random sample of 898 patients from the SOLVD Registry who had either radiological evidence of congestive heart failure and/or an ejection fraction of 0.45 or less were enrolled in the substudy and underwent a detailed clinical evaluation including a 6-minute walk test. Patients were followed up for a mean of 242 days.

Outcome Measures.
—Mortality and hospitalization.

Results.
—During follow-up, 52 walk-test participants (6.2%) died and 252 (30.3%) were hospitalized. Hospitalization for congestive heart failure occurred in 78 participants (9.4%), and the combined endpoint of death or hospitalization for congestive heart failure occurred in 114 walk-test participants (13.7%). Compared with the highest performance level, patients in the lowest performance level had a significantly greater chance of dying (10.23% vs 2.99%; P=.01), of being hospitalized (40.91% vs 19.90%; P=.002), and of being hospitalized for heart failure (22.16% vs 1.99%; P<.0001). In a logistic regression model, ejection fraction and distance walked were equally strong and independent predictors of mortality and heart failure hospitalization rates during follow-up.

Conclusion.
—The 6-minute walk test is a safe and simple clinical tool that strongly and independently predicts morbidity and mortality in patients with left ventricular dysfunction.

(JAMA. 1993;270:1702-1707)

Author Affiliations
From the Department of Medicine, University of Alabama at Birmingham (Drs Bittner and Rogers); the Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill (Ms Weiner and Dr Bangdiwala); the Division of Epidemiology and Clinical Applications, National Institutes of Health, Bethesda, Md (Dr Yusuf); the Departments of Medicine and Research, Brigham and Women's Hospital, Boston, Mass, the Veterans Affairs Medical Center, West Roxbury, Mass, and Harvard Medical School, Boston, Mass (Dr McIntyre); the Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn (Dr Kronenberg); the Department of Medicine and Pharmacology, Robert Wood Johnson Medical School, New Brunswick, NJ (Dr Kostis); Departments of Medicine and Research, State University of New York at Buffalo (Dr Kohn); the Department of Medicine, Oregon Health Sciences University, Portland (Ms Guillotte and Dr Greenberg); Veterans Affairs Medical Center, Manchester, NH (Ms Woods); and the Montreal (Quebec) Heart Institute Research Center (Dr Bourassa). Dr Yusuf is now affiliated with the Department of Medicine, McMaster University, Hamilton, Ontario. Dr Kronenberg is now affiliated with the Department of Medicine, University of Texas Medical Branch, Galveston.

Footnotes
A complete list of the SOLVD investigators may be found in Bangdiwala SI, Weiner DH, Bourassa MG, Friesinger GC II, Ghali JK, Yusuf S, for the SOLVD Investigators. Studies of Left Ventricular Dysfunction (SOLVD) Registry: rationale, design, methods and description of baseline characteristics. Am J Cardiol. 1992;70:347-353.

Reprint requests to Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, THT 328-UAB Station, Birmingham, AL 35294 (Dr Bittner).

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