Abstract
BackgroundPatients with Heart Failure (HF) show impaired functional capacities which have been related to their prognosis. Moreover, physical functional performance in functional tests has also been related to the prognosis in patients with HF. Thus, it would be useful to investigate how physical functional performance in functional tests could determine the prognosis in patients with HF, because HF is the leading cause of hospital admissions for people older than 65 years old. This systematic review and meta-analysis aims to summarise and synthesise the evidence published about the relationship between physical functional performance and prognosis in patients with HF, as well as assess the risk of bias of included studies and the level of evidence per outcome.MethodsMajor electronic databases, such as PubMed, AMED, CINAHL, EMBASE, PEDro, Web of Science, were searched from inception to March 2020 for observational longitudinal cohort studies (prospective or retrospective) examining the relationship between physical functional performance and prognosis in patients with HF.Results44 observational longitudinal cohort studies with a total of 22,598 patients with HF were included. 26 included studies reported a low risk of bias, and 17 included studies showed a moderate risk of bias. Patients with poor physical functional performance in the Six Minute Walking Test (6MWT), in the Short Physical Performance Battery (SPPB) and in the Gait Speed Test showed worse prognosis in terms of larger risk of hospitalisation or mortality than patients with good physical functional performance. However, there was a lack of homogeneity regarding which cut-off points should be used to stratify patients with poor physical functional performance from patients with good physical functional performance.ConclusionThe review includes a large number of studies which show a strong relationship between physical functional performance and prognosis in patients with HF. Most of the included studies reported a low risk of bias, and GRADE criteria showed a low and a moderate level of evidence per outcome.
Highlights
Patients with Heart Failure (HF) show impaired functional capacities which have been related to their prognosis
Characteristics of included studies A total of 3881 citations were identified through electronic databases, with 263 additional studies identified through Grey Literature Sources and 14 studies identified through manual search
GS Gait Speed decreased the meters (m) they walked in the 6-min walk test (6MWT) during follow-up showed larger risk of All-Cause of Mortality [Hazard Ratio (HR) = 1.22 95% Confidence Interval (95%CI) (1.10–1.36), p < 0.001], there was no lower risk of All-Cause of Mortality between patients with HFrEF, patients with HFpEF and patients with acute HF who increased the meters they walked in the 6MWT during follow-up (Additional file 5)
Summary
Patients with Heart Failure (HF) show impaired functional capacities which have been related to their prognosis. Physical functional performance in functional tests has been related to the prognosis in patients with HF. It would be useful to investigate how physical functional performance in functional tests could determine the prognosis in patients with HF, because HF is the leading cause of hospital admissions for people older than 65 years old. There are several functional symptoms that appear in patients with HF, such as reduced aerobic capacity, decreased muscle strength, low weekly physical activity and exercise intolerance, which are accompanied by fatigue and dyspnea symptoms [12,13,14,15,16,17]. The lower extremities muscle mass and muscle strength have been related to long-term survival in patients with HF [14, 21]
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