Prognostic Role of the Six-Minute Walk Test at Discharge for Predicting Readmission in Acute Decompensated Heart Failure

Background: Despite improvements in treatment approaches, acute decompensated heart failure (ADHF) continues to have a high rate of early readmissions. Currently, the majority of prognostic models examining ADHF patients utilize static clinical parameters to identify patients who are at risk, but they tend to miss the patients categorized as "high-risk." The 6-minute walk test (6MWT) is simple, inexpensive, and effective in measuring an individual's functional capacity and might provide more prognostic information. Material and Methods: A Prospective Observational Study was conducted on 51 patients admitted for First-Episode ADHF to Teerthanker Mahaveer Medical College and Research Centre, Moradabad, India. Information regarding demographics, clinical, laboratory, and echocardiographic values was taken. All patients performed a standardized 6MWT before discharge, and the 6MWD was recorded. All patients were followed for the outcome of all-cause readmissions for 90 days post-discharge. Statistical tests included Welch's t-tests, Pearson's correlation, Receiver Operating Characteristics (ROC) curve analysis, and logistic regressions. Results: The mean age was 56.3 ± 11.3 years, with 51% male. The mean 6MWD was 364.6 ± 122.2 m. Of the 90 days after discharge, 33 patients (64.7%) were readmitted. Readmitted patients had a mean lower 6MWD than patients without readmission (298.5 ± 90.3 m vs 485.8 ± 67.5; p < 0.001). The ROC analysis identified a 360 m threshold to determine readmission status with the highest accuracy (AUC = 0.76; sensitivity = 69%, specificity = 72%). Logistic regression demonstrated that a 10 m decrease in 6MWD increased the odds of readmission by 40% (OR = 1.40; 95% CI 1.14–1.72; p = 0.001). Conclusion: Decreased discharge 6MWD significantly predicts early readmission in ADHF. Assessing 6MWT during discharge may help identify patients at high risk of readmission for further follow-up and targeted intervention. Keywords: Acute Decompensated Heart Failure, Six-Minute Walk Test, Functional capacity, Hospital readmission, Prognostic marker.