Incremental Value of Gait Speed in Predicting Prognosis of Older Adults With Heart Failure

Pulignano, Giovanni; Sindaco, Donatella Del; Lenarda, Andrea Di; Alunni, Gianfranco; Senni, Michele; Tarantini, Luigi; Cioffi, Giovanni; Tinti, Maria Denitza; Barbati, Giulia; Minardi, Giovanni; Uguccioni, Massimo; Investigators, Image-Hf Study

doi:10.1016/j.jchf.2015.12.017

Cited by 102 publications

(80 citation statements)

References 42 publications

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“…Frailty is a multi‐domain syndrome and may be under‐represented by a single measure such as grip strength. Gait speed has been associated with survival in chronic HF patients and warrants testing as an alternative single‐item marker for frailty alongside Mini‐Cog in future investigations in this population. The Mini‐Cog test is a screening tool rather than a diagnostic one, and its generalizability may be limited given that there are multiple other screening tools for cognitive impairment currently in use with a lack of consensus about which one should be used in HF patients .…”

Section: Discussionmentioning

confidence: 99%

Prospective assessment of combined handgrip strength and Mini‐Cog identifies hospitalized heart failure patients at increased post‐hospitalization risk

et al. 2018

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AimsThe utility of combined assessment of both frailty and cognitive impairment in hospitalized heart failure (HF) patients for incremental post‐discharge risk stratification, using handgrip strength and Mini‐Cog as feasible representative parameters, was investigated.Methods and resultsA prospective, single‐centre cohort study of older adults (age ≥65) hospitalized for HF being discharged to home was performed. Pre‐discharge, grip strength was assessed using a dynamometer (Jamar hydrolic hand dynamometer, Lafayette Instruments, Lafayette, IN, USA) and was defined as weak if the maximal value was below the gender‐derived and body mass index‐derived cut‐offs according to Fried criteria. Cognition was assessed using the Mini‐Cog. The presence of impairment was defined as a score of <2. Outcome measures were all‐cause readmission or emergency department visit (primary) or all‐cause mortality (secondary) at 6 months. A total of 56 patients (mean age 77 ± 7 years, 73% male) were enrolled. The majority (n = 33, 59%) had weak grip strength, either with (n = 5) or without (n = 28) cognitive impairment. The highest risk for both readmission and mortality occurred in those with weak grip strength and cognitive impairment in combination (log‐rank P < 0.0001 and P = 0.01, respectively).ConclusionsPatients who are frail by grip strength assessment and cognitively impaired according to severely reduced Mini‐Cog performance show the worst midterm post‐discharge outcomes after HF hospitalization.

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Section: Discussionmentioning

confidence: 99%

Prospective assessment of combined handgrip strength and Mini‐Cog identifies hospitalized heart failure patients at increased post‐hospitalization risk

et al. 2018

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“…7 In addition, numerous investigations have demonstrated that gait speed reflects the degree of frailty well and is a useful marker for predicting the early and late clinical outcomes in patients with particular subsets of cardiovascular disease undergoing invasive cardiac surgery. [8][9][10][11] Therefore, we investigated the usefulness of gait speed as a frailty measure predicting the prognosis of patients who underwent TAVR procedures using data from a Japanese multicenter registry.…”

Section: Kano Et Al Gait Speed and Clinical Outcomes After Tavrmentioning

confidence: 99%

Gait Speed Can Predict Advanced Clinical Outcomes in Patients Who Undergo Transcatheter Aortic Valve Replacement

Kano¹,

Yamamoto²,

Shimura³

et al. 2017

Circ: Cardiovascular Interventions

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R ecently, the indication for transcatheter aortic valve replacement (TAVR) has been expanded not only to patients with degenerative aortic stenosis considered inoperable or of high surgical risk but also to those with intermediate surgical risk. [1][2][3] Thus, optimal patient risk stratification should be performed before the TAVR procedure. Frailty, which is not captured in the classical surgical risk model, is considered highly prevalent in elderly vulnerable patients and can be characterized by Background-Gait speed reflects an important factor of frailty and is associated with an increased risk of late mortality in patients with cardiac disease. This study sought to assess the prognostic value of gait speed in elderly patients who underwent transcatheter aortic valve replacement. Methods and Results-We investigated the 5-m or 15-feet gait speed (m/sec) in 1256 patients who underwent transcatheter aortic valve implantation using data from the OCEAN-TAVI Japanese multicenter registry (Optimized Catheter Valvular Intervention-Transcatheter Aortic Valve Implantation). Baseline characteristics, procedural outcomes, and all-cause mortality were compared among groups defined by differential gait speed classification: model 1, normal (>0.83 m/sec; n=563; 44.8%), slow (0.5-0.83 m/sec; n=429; 34.2%), slowest (<0.83 m/sec; n=205; 16.3%), unable to walk (n=48; 3.8%); and model 2, classification and regression tree survival model indicating the threshold of gait speed as 0.385 m/sec (>0.385 m/sec; n=1080 versus ≤0.385 m/sec; n=117). The cumulative 1-year mortality rate showed significant differences in the classical gait speed groups in model 1 (7.6%, 6.6%, 18.2%, and 40.7%, respectively; P<0.001) and survival classification and regression tree group in model 2 (7.7% versus 21.9%; P<0.001). The slowest walkers and those unable to walk demonstrated independent associations with increased midterm mortality after adjustment for several confounding factors (hazard ratio, 1.83, 4.28; 95% confidence interval, 1.03-3.26, 2.22-8.72; P=0.039, <0.001, respectively). Gait speed <0.385 m/sec determined by classification and regression tree also independently associated with worse prognosis (hazard ratio, 2.40; 95% confidence interval, 1.75-5.88; P=0.001). Conclusions-Gait speed using both traditional and specific classification is useful as a potential marker for predicting vulnerable patients associated with adverse clinical outcomes after transcatheter aortic valve replacement. (Circ Cardiovasc Interv. 2017;10:e005088.

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“…In contrast to multi-item frailty scales, 4-meter gait speed, and to a lesser extent handgrip strength, has been advocated as a single-item measure of frailty that often outperforms more elaborate and time-consuming scales. Chaudhry et al (33) showed that in HF patients slow gait speed and weak grip strength were powerful predictors of hospitalizations, and in a recent study, we found that slow gait speed is independently associated with death, hospitalization for HF, and all-cause hospitalization in older HF patients (34). …”

Section: Frailty and Cognitive Dysfunction As Markers Of Complexity Imentioning

confidence: 65%

Atrial Fibrillation Management in Older Heart Failure Patients: A Complex Clinical Problem

Pulignano

Sindaco

Tinti

et al. 2016

Heart International

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BackgroundAtrial fibrillation (AF) and heart failure (HF), two problems of growing prevalence as a consequence of the ageing population, are associated with high morbidity, mortality, and healthcare costs. AF and HF also share common risk factors and pathophysiologic processes such as hypertension, diabetes mellitus, ischemic heart disease, and valvular heart disease often occur together. Although elderly patients with both HF and AF are affected by worse symptoms and poorer prognosis, there is a paucity of data on appropriate management of these patients.MethodsPubMed was searched for studies on AF and older patients using the terms atrial fibrillation, elderly, heart failure, cognitive impairment, frailty, stroke, and anticoagulants.ResultsThe clinical picture of HF patients with AF is complex and heterogeneous with a higher prevalence of frailty, cognitive impairment, and disability. Because of the association of mental and physical impairment to non-administration of oral anticoagulants (OACs), screening for these simple variables in clinical practice may allow better strategies for intervention in this high-risk population. Since novel direct OACs (NOACs) have a more favorable risk-benefit profile, they may be preferable to vitamin K antagonists (VKAs) in many frail elderly patients, especially those at higher risk of falls. Moreover, NOACs are simple to administer and monitor and may be associated with better adherence and safety in patients with cognitive deficits and mobility impairments.ConclusionsLarge multicenter longitudinal studies are needed to examine the effects of VKAs and NOACs on long-term cognitive function and frailty; future studies should include geriatric conditions.

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Incremental Value of Gait Speed in Predicting Prognosis of Older Adults With Heart Failure

Cited by 102 publications

References 42 publications

Prospective assessment of combined handgrip strength and Mini‐Cog identifies hospitalized heart failure patients at increased post‐hospitalization risk

Prospective assessment of combined handgrip strength and Mini‐Cog identifies hospitalized heart failure patients at increased post‐hospitalization risk

Gait Speed Can Predict Advanced Clinical Outcomes in Patients Who Undergo Transcatheter Aortic Valve Replacement

Atrial Fibrillation Management in Older Heart Failure Patients: A Complex Clinical Problem

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