Impact of physical performance on prognosis among patients with heart failure: Systematic review and meta-analysis

Abstract

Background: This study aimed to clarify the relationship between physical performance and prognosis of patients with heart failure using a meta-analysis given the inconsistencies in published studies regarding the same.

Methods: A total of 22 studies with 10,368 patients were included in this review. Hazard ratios were used for analysis, while meta-analysis was performed using the inverse-variance method. Among all physical performance tests reported in the literature, the six-minute walk distance (6MD) test was most frequently used. However, short physical performance battery (SPPB) and walking speed were more frequently used as outcomes among studies investigating patients with a higher mean age.

Results: The results of our meta-analysis showed that 6MD cut-off values were significantly associated with mortality [hazard ratio (HR), 2.04; 95% confidence interval (CI), 1.48-2.83; p<0.001] and cardiovascular disease (HR, 2.18; 95% CI, 1.68-2.83; p<0.001). Although a number of studies have also reported on the relationship between other physical performance tests and prognosis, meta-analysis could not be performed. Our results revealed that physical performance was strongly correlated with prognosis among patients with heart failure.

Conclusions: Our meta-analysis showed a strong relationship between 6MD and prognosis. However, studies investigating more elderly patients have tended to more frequently utilize walking speed and SPPB as outcomes.

Keywords: Heart failure; Meta-analysis; Physical performance; Secondary prevention.