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Use of the 6-min walk distance to identify variations in treatment benefits from implantable cardioverter-defibrillator and amiodarone: results from the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial).

Publication ,  Journal Article
Fishbein, DP; Hellkamp, AS; Mark, DB; Walsh, MN; Poole, JE; Anderson, J; Johnson, G; Lee, KL; Bardy, GH; SCD-HeFT Investigators,
Published in: J Am Coll Cardiol
June 17, 2014

OBJECTIVES: The purpose of this study was to determine if 6-min walk test data assists in treatment decisions for patients with heart failure. BACKGROUND: In the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial), a pre-specified subgroup analysis showed that patients with New York Heart Association functional class III symptoms did not benefit from implantable cardioverter-defibrillator (ICD) therapy and appeared to be harmed by amiodarone, whereas New York Heart Association functional class II patients obtained significant survival benefit from ICD. We postulated that a more objective measure of functional capacity, such as 6-min walk (6MW) distance, might provide a better tool for selecting these preventive therapies. METHODS: A 6MW test was performed before randomization in 2,397 patients. Median follow-up was 45.5 months. All-cause mortality was the primary endpoint, with cause-specific mortality (heart failure, arrhythmic) examined in secondary analyses. RESULTS: The hazard ratios (HRs) for ICD therapy compared to placebo were estimated within tertiles of baseline 6MW distance: HR: 0.42 (95% confidence interval [CI]: 0.26 to 0.66) for 6MW distance >386 m (top tertile); HR: 0.57 (95% CI: 0.39 to 0.83) for 6MW distance 288 to 386 m (middle tertile); and HR: 1.02 (95% CI: 0.75 to 1.39) for 6MW distance <288 m (bottom tertile). The corresponding HRs for amiodarone compared to placebo were 0.68 (95% CI: 0.46 to 1.02) for the top, 0.86 (95% CI: 0.61 to 1.21) for the middle, and 1.56 (95% CI: 1.17 to 2.09) for the bottom tertile. The 6MW distance was inversely related to heart failure-related mortality but not to arrhythmic mortality. ICD therapy reduced arrhythmic mortality in the top 2 tertiles of 6MW, but had no effect on heart failure mortality. CONCLUSIONS: A baseline 6MW distance <288 m identified a subgroup of SCD-HeFT patients who were harmed by amiodarone therapy and did not benefit from ICD. (Sudden Cardiac Death in Heart Failure Trial [SCD-HeFT]; NCT00000609).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

June 17, 2014

Volume

63

Issue

23

Start / End Page

2560 / 2568

Location

United States

Related Subject Headings

  • Walking
  • United States
  • Treatment Outcome
  • Time Factors
  • Survival Rate
  • Stroke Volume
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
 

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Fishbein, D. P., Hellkamp, A. S., Mark, D. B., Walsh, M. N., Poole, J. E., Anderson, J., … SCD-HeFT Investigators, . (2014). Use of the 6-min walk distance to identify variations in treatment benefits from implantable cardioverter-defibrillator and amiodarone: results from the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial). J Am Coll Cardiol, 63(23), 2560–2568. https://doi.org/10.1016/j.jacc.2014.02.602
Fishbein, Daniel P., Anne S. Hellkamp, Daniel B. Mark, Mary Norine Walsh, Jeanne E. Poole, Jill Anderson, George Johnson, Kerry L. Lee, Gust H. Bardy, and Gust H. SCD-HeFT Investigators. “Use of the 6-min walk distance to identify variations in treatment benefits from implantable cardioverter-defibrillator and amiodarone: results from the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial).J Am Coll Cardiol 63, no. 23 (June 17, 2014): 2560–68. https://doi.org/10.1016/j.jacc.2014.02.602.
Fishbein DP, Hellkamp AS, Mark DB, Walsh MN, Poole JE, Anderson J, Johnson G, Lee KL, Bardy GH, SCD-HeFT Investigators. Use of the 6-min walk distance to identify variations in treatment benefits from implantable cardioverter-defibrillator and amiodarone: results from the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial). J Am Coll Cardiol. 2014 Jun 17;63(23):2560–2568.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

June 17, 2014

Volume

63

Issue

23

Start / End Page

2560 / 2568

Location

United States

Related Subject Headings

  • Walking
  • United States
  • Treatment Outcome
  • Time Factors
  • Survival Rate
  • Stroke Volume
  • Middle Aged
  • Male
  • Humans
  • Heart Failure