244 Derivation and validation of a clinical risk-model in heart failure based on 6-min walk test performance and NT-proBNP status

Introduction:Chronic heart failure (CHF) trials have frequently reported that 6-min walk test (6-MWT) distance and NT-proBNP status are important prognostic indicators. We wished to provide a risk profile, adjusted by sex and beta-blocker (BBL) usage, from two large cohorts of patients in Germany and the UK. Methods:We included 1100 patients with systolic CHF from the University Hospital Heidelberg, Germany in a derivation cohort and validated these against 676 patients with similar aetiology from the Department of Academic Cardiology, University of Hull, UK. Serial log-rank analysis identified and validated the individual cut-off for optimal risk stratification for all-cause mortality according to sex and BBL status. Patients at increased risk according to 6-MWT distance were also stratified by NT-proBNP status. Results: In both cohorts, 6-MWT was an independent predictor of mortality. Patients not prescribed BBL with a 6-MWT distance of ≤430m (males) and ≤360m (females) had a higher all-cause mortality risk. For patients prescribed BBL, risk cut-points were adjusted accordingly: ≤370m (males), and≤330m (females). Patients with an adverse 6-MWT had a risk profile based on NT-proBNP status of ≤650ng/l (males) and ≤710ng/l (females). Three clinical risk groups were formed with a 1-year mortality of 3.6%, 9.6% and 24.4%, respectively (P<0.0001).