Cut-off values of 6-min walk test and sit-to-stand test for determining symptom burden in atrial fibrillation

Abstract

Background Since symptomatology is a major predictor of quality of life and an endpoint for the management of atrial fbrillation (AF), practical approaches for objectively interpreting symptom burden and functional impairment are needed.

Aims We aimed to provide cut-of values for two frequently used feld tests to be able to objectively interpret symptom burden in atrial fbrillation.

Methods One hundred twenty-fve patients with AF were evaluated with European Heart Rhythm Association (EHRA) score, 6-min walk test (6MWT), 30 s sit-to-stand test (30 s-STST), Short-Form 36 (SF-36), International Physical Activity Questionnaire-Short Form (IPAQ-SF), and spirometry. Patients with EHRA 1 were classifed as “asymptomatic”, and those with EHRA 2–4 as “symptomatic”. Cut-of values of 6MWT and 30 s-STST for discriminating between these patients were calculated.

Results The optimal cut-of value was “450 m” for 6MWT (sensitivity: 0.71; specifcity of 0.79) and “11 repetitions” for 30 s-STST (sensitivity 0.77; specifcity of 0.70). Area under ROC curve was 0.75 for both tests (p<0.001). Subgroup analysis revealed patients below cut-of values also had worse outcomes in SF-36, IPAQ-SF, and spirometry.

Conclusions In patients with AF, walking < 450 m in 6MWT or performing < 11 repetitions in 30 s-STST indicates increased symptom burden, as well as impaired exercise capacity, quality of life, physical activity participation, and pulmonary function. These cut-of values may help identifying patients who may require adjustments in their routine treatment or who may beneft from additional rehabilitative approaches.