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Slow gait speed may predict mortality, hospitalization in older patients with HF
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The association between reduced gait speed and mortality or hospitalization in older patients with HF may offer a simple way to predict prognosis, researchers reported in JACC: Heart Failure.
In the IMAGE-HF study, researchers evaluated gait speed as a part of frailty assessment in 331 older patients with HF from seven HF clinics in Italy. All patients were aged 70 years or older (mean age, 78 years; 43% women; mean left ventricular ejection fraction 35 11%; mean NYHA class 2.7 0.6) and were enrolled in 2007.
All patients were given a 4-m corridor walk test and placed into tertiles based on gait speed: up to 0.65 m/s, 0.66 m/s to 0.99 m/s and at least 1 m/s. They were then followed up for 1 year. Primary endpoints were all-cause mortality, HF hospitalization and all-cause hospitalization.
Mean gait speed was 0.74 0.23 m/s, and 115 patients were in the lowest tertile, the researchers reported.
During follow-up, 80 patients (24.2%) died, 125 (37.8%) were hospitalized for HF and 198 (59.8%) were hospitalized for other reasons.
The researchers found that 1-year mortality was higher in the lowest and intermediate tertiles: 38.3% ( 0.65 m/s), 21.9% (0.66-0.99 m/s) and 9.1% ( 1 m/s; P < .001).
After adjustment for age, EF, systolic BP and beta-blocker therapy, faster gait speed was associated with lower risk for all-cause death (HR = 0.62; 95% CI, 0.43-0.88), they wrote.
According to the data, gait speed also was a predictor of risk for HF hospitalization (lowest tertile, 48.7%; highest tertile, 25%; P = .002) and all-cause hospitalizations (lowest tertile, 71.3%; highest tertile, 26.6%; P = .002),
When added to the Cardiac and Comorbid Conditions HF score, gait speed improved risk stratification for all-cause mortality (net reclassification improvement = 0.49; P < .001) and HF hospitalizations (net reclassification improvement = 0.37; P < .001).
Those with reduced gait speed were also more likely to have atrial fibrillation, a Mini Mental State Examination score of less than 24 and preserved LVEF.
The researchers wrote that for high-risk patients, a slow gait speed was linked to a nearly fivefold increase in mortality compared with patients who could achieve a faster gait, and for the lowest-risk patients, there was a more than sixfold risk for mortality associated with slow gait speed.
“Assessment of frailty using gait speed is simple and should be part of the clinical evaluation process,” the researchers wrote. “Early detection of frailty may potentially lead to interventions aimed at preventing or reversing the development of frailty, such as regular exercise and balanced nutrition.”
They wrote that future studies are still needed to determine whether such interventions actually lead to improved clinical outcomes. – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures.
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