The impact of delayed treatment on 6-minute walk distance test in patients with pulmonary arterial hypertension: A meta-analysis

Int J Cardiol. 2018 Mar 1;254:299-301. doi: 10.1016/j.ijcard.2017.12.016. Epub 2017 Dec 14.


Background: The impact of treatment delay in stable patients with pulmonary arterial hypertension (PAH) remains unaddressed.

Methods: This meta-analysis included six datasets of PAH therapies with randomized-controlled trials (RCT) and corresponding open-label extension (OLE) studies. We evaluated the change in 6MWD at 1year in the OLE studies by active treatment versus ex-placebo group. The ex-placebo group (i.e., the patients randomized to placebo in the RCT and ultimately treated with active therapy in the OLE) represented the "delay-in-treatment" population.

Results: Patients with a treatment delay of 12-16weeks in PAH targeted therapy had an improvement in 6-minute walk distance (6MWD) test at 1year, but this improvement did not amount to the same degree of improvement as their initially treated counterparts. The difference in 6MWD was 15m to 20m at 1year.

Conclusion: A short-term delay in PAH targeted therapy may adversely affect functional capacity in patients with PAH. This meta-analysis provides some insight as to whether earlier treatment would benefit stable patients with PAH.

Keywords: 6-minute walk distance; Delayed treatment; Early treatment; Functional capacity; Pulmonary arterial hypertension.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Exercise Test / methods
  • Exercise Test / trends*
  • Humans
  • Hypertension, Pulmonary / diagnosis
  • Hypertension, Pulmonary / physiopathology*
  • Hypertension, Pulmonary / therapy*
  • Randomized Controlled Trials as Topic / methods
  • Time-to-Treatment / trends*
  • Treatment Outcome
  • Walking / physiology*