Pharmacological trials including patients with more severe heart failure were more likely to show a significant improvement with therapy than trials of milder heart failure .
Using mean values in these trials , the age of patients appeared a more important determinant of 6MWT distance than New York Heart Association classification .
The 6MWT has not yet been proven to be a robust test for the identification of effective pharmacological interventions although it appears useful for the assessment of cardiac resynchronization therapy .
The results of the 6MWT were concordant with changes in symptoms , suggesting that it may be used as supportive evidence for symptom benefit .
AIMS The 6 min walk test ( 6MWT ) is commonly used in clinical trials to assess treatments for heart failure , but its ability to distinguish between effective and ineffective treatments is question able .
The aim of this study is to investigate , using a systematic literature review , the utility of the 6MWT as a measure of the effectiveness of treatment in r and omized controlled trials of heart failure .
Beta blockers in heart failure: a comparison of a vasodilating beta blocker with metoprolol.
OBJECTIVE To determine whether a third generation vasodilating beta blocker ( celiprolol ) has long term clinical advantages over metoprolol in patients with chronic heart failure . DESIGN A double blind placebo controlled r and omised trial . SETTING University teaching Hospital . PATIENTS 50 patients with stable chronic heart failure ( NYHA class II-IV ) due to idiopathic dilated , ischaemic , or hypertensive cardiomyopathy , with left ventricular ejection fraction < 0.45 . INTERVENTIONS Celiprolol 200 mg daily ( n = 21 ) , metoprolol 50 mg twice daily ( n = 19 ) , or placebo ( n = 10 ) for three months with a four week dose titration period . After the double blind period , patients entered an open label study ( with placebo group receiving beta blockers ) and were assessed after one year . MAIN OUTCOME MEASURES Clinical response , efficacy , and tolerance were assessed by the Minnesota heart failure symptom question naire six minute walk test , Doppler echocardiography ( systolic and diastolic function ) , radionuclide ventriculography , and atrial and brain natriuretic peptides measured at baseline and after three months . RESULTS In the metoprolol group at 12 weeks v baseline there was a 47 % reduction in symptom score ( p < 0.001 ) , improvement of NYHA class ( mean ( SEM ) , 2.6 ( 0.12 ) to 1.9 ( 0.13 ) , p = 0.001 ) , exercise distance ( 1246 ( 54 ) to 1402 ( 52 ) feet , p < 0.001 ) , and left ventricular ejection fraction ( 26.9(3.1)% to 31(3.0)% , p = 0.016 ) , and a fall in heart rate ( resting , 79 ( 3 ) to 62 ( 3 ) beats/min , p < 0.001 ) . In the celiprolol group there was a 38 % reduction in symptom score ( p = 0.02 ) , less improvement in exercise distance ( 1191 ( 55 ) to 1256 ( 61 ) feet , p = 0.05 ) , and no significant changes in NYHA class , left ventricular ejection fraction , or heart rate . Mortality at one year was 11 % in metoprolol and 19 % in the celiprolol group , and symptomatic improvement was maintained in the survivors . CONCLUSIONS Both drugs were well tolerated but the vasodilator properties of celiprolol do not seem to provide any obvious additional benefit in the long term treatment of heart failure
Pharmacological trials including patients with more severe heart failure were more likely to show a significant improvement with therapy than trials of milder heart failure .
Using mean values in these trials , the age of patients appeared a more important determinant of 6MWT distance than New York Heart Association classification .
The 6MWT has not yet been proven to be a robust test for the identification of effective pharmacological interventions although it appears useful for the assessment of cardiac resynchronization therapy .
The results of the 6MWT were concordant with changes in symptoms , suggesting that it may be used as supportive evidence for symptom benefit .
AIMS The 6 min walk test ( 6MWT ) is commonly used in clinical trials to assess treatments for heart failure , but its ability to distinguish between effective and ineffective treatments is question able .
The aim of this study is to investigate , using a systematic literature review , the utility of the 6MWT as a measure of the effectiveness of treatment in r and omized controlled trials of heart failure .