Impact of Gait Speed and Instrumental Activities of Daily Living on All-Cause Mortality in Adults ≥65 Years With Heart Failure

Abstract

Mobility and function are important predictors of survival. However, their combined impact on mortality in adults ≥65 years of age with heart failure (HF) is not well understood. This study examined the role of gait speed and instrumental activities of daily living (IADL) in all-cause mortality in a cohort of 1,119 community-dwelling Cardiovascular Health Study participants ≥65 years of age with incident HF. Data on HF and mortality were collected through annual examinations or contact during the 10-year follow-up period. Slower gait speed (<0.8m/s vs. ≥0.8m/s) and IADL impairment (≥1 vs. 0 areas of dependence) were determined from baseline and follow-up assessments. A total of 740 (66%) of the 1119 participants died during the follow-up period. Multivariate Cox proportional hazards models showed that impairments in either gait speed (hazard ratio 1.37, 95% CI 1.10-1.70; p=0.004) or IADL (HR 1.56, 95% CI 1.29-1.89; p<0.001), measured within 1 year before the diagnosis of incident HF, were independently associated with mortality, adjusting for socio-demographic and clinical characteristics. The combined presence of slower gait speed and IADL impairment was associated with a greater risk of mortality and suggested an additive relationship between gait speed and IADL. In conclusion, gait speed and IADL are important risk factors for mortality in adults ≥65 years of age with HF, but the combined impairments of both gait speed and IADL can have an especially important impact on mortality.

Gait Speed Predicts 30-Day Mortality After Transcatheter Aortic Valve Replacement

“…Our data are more in line with the median gait speed of 0.57 m/s found in a TAVR referral population 17 and 0.38 m/s found in a substudy of the Placement of Aortic Transcatheter Valve (PARTNER) trial. 38 Previously, a gait speed of 0.83 m/s has been proposed as a cutoff with good discrimination properties in a population with heart failure 12 and a population undergoing cardiac surgery. 13 However, >75% of our TAVR population had a gait speed of <0.83 m/s, and one quarter had a gait speed of <0.5 m/s.…”

“…Gait speed, alone or incorporated into geriatric rating scales, is associated with mortality among community-dwelling individuals, 10 patients with coronary heart disease, 11 elderly patients with heart failure, 12 and those undergoing cardiac surgery, including aortic valve replacement.…”

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Gait speed, alone or incorporated into geriatric rating scales, is associated with mortality among community-dwelling individuals, 10 patients with coronary heart disease, 11 elderly patients with heart failure, 12 and those undergoing cardiac surgery, including aortic valve replacement.13 Nevertheless, the association between slow gait speed (which is an indicator of physical frailty) and outcomes after TAVR in US Background-Surgical risk scores do not include frailty assessments (eg, gait speed), which are of particular importance for patients with severe aortic stenosis considering transcatheter aortic valve replacement. Methods and Results-We assessed the association of 5-m gait speed with outcomes in a cohort of 8039 patients who underwent transcatheter aortic valve replacement (November 2011-June 2014) and were included in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.

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Sarcopenia: Prevalence and Prognostic Implications in Elderly Patients with Cardiovascular Disease

“…[31][32][33] The prevalence rates of weakness and slowness among elderly participants vary depending on the population and the definitions used [34]. In the NILS-LSA study, a population-based survey of aging, the prevalence rates of weakness and slowness defined according to the AWGS criteria were 15.7% and 7.3%, respectively (10.0% and 5.4% in men, and 15.7% and 9.1% in women) [35].…”

Heart failure as a predictor of functional dependence in hospitalized elderly

“…Early identification of elderly at higher risk of dependence can help to minimize the adverse consequences of hospitalization and therefore individualized nursing actions will be able to meet care demands compatible with the functional performance of the elderly. HF was previously identified as a risk factor for greater dependence in elderly (6)(7) . There were no national studies that could identify whether HF is a dependence predictor in hospitalized elderly.…”