Incremental Value of Gait Speed in Predicting Prognosis of Older Adults With Heart Failure: Insights From the IMAGE-HF Study

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• 作者：Giovanni Pulignano ; MD^a ; ^{gipulig@yahoo.it" class="auth_mail" title="E-mail the corresponding author} ; Donatella Del Sindaco ; MD^b ; Andrea Di Lenarda ; MD^c ; Gianfranco Alunni ; MD^d ; Michele Senni ; MD^e ; Luigi Tarantini ; MD^f ; Giovanni Cioffi ; MD^g ; Maria Denitza Tinti ; MD^a ; Giulia Barbati ; PhD^c ; Giovanni Minardi ; MD^a ; Massimo Uguccioni ; MD^a ; on behalf of the IMAGE-HF Study InvestigatorsGiovanni Gaschino ; Luigi Tarantini ; Giovanni Cioffi ; Andrea Di Lenarda ; Giulia Russo ; Donatella Radini ; Kira Stellato ; Michele Senni ; Gianfranco Alunni ; Adriano Murrone ; Cinzia Zuchi ; Giovanni Pulignano ; Donatella Del Sindaco ; Stefano Tolone ; Maria Denitza Tinti ; Luca Monzo ; Giovanni Minardi ; Massimo Uguccioni
• 关键词：elderly ; gait speed ; heart failure ; hospitalization ; prognosis
• 刊名：JACC: Heart Failure
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：4
• 期：4
• 页码：289-298
• 全文大小：967 K

文摘

The aim of this study was to assess the relationship between gait speed and the risk for death and/or hospital admission in older patients with heart failure (HF).

Background

Gait speed is a reliable single marker of frailty in older people and can predict falls, disability, hospital admissions, and mortality.

Methods

In total, 331 community-living patients ≥70 years of age (mean age 78 ± 6 years, 43% women, mean ejection fraction 35 ± 11%, mean New York Heart Association functional class 2.7 ± 0.6) in stable condition and receiving optimized therapy for chronic HF were prospectively enrolled and followed for 1 year. Gait speed was measured at the usual pace over 4 m, and cutoffs were defined by tertiles: ≤0.65, 0.66 to 0.99, and ≥1.0 m/s.

Results

There was a significant association between gait speed tertiles and 1-year mortality: 38.3%, 21.9%, and 9.1% (p < 0.001), respectively. On multivariate analysis, gait speed was associated with a lower risk for all-cause death (hazard ratio: 0.62; 95% confidence interval: 0.43 to 0.88) independently of age, ejection fraction <20%, systolic blood pressure, anemia, and absence of beta-blocker therapy. Gait speed was also associated with a lower risk for hospitalization for HF and all-cause hospitalization. When gait speed was added to the multiparametric Cardiac and Comorbid Conditions Heart Failure risk score, it improved the accuracy of risk stratification for all-cause death (net reclassification improvement 0.49; 95% confidence interval: 0.26 to 0.73, p < 0.001) and HF admissions (net reclassification improvement 0.37; 95% confidence interval: 0.15 to 0.58; p < 0.001).

Conclusions

Gait speed is independently associated with death, hospitalization for HF, and all-cause hospitalization and improves risk stratification in older patients with HF evaluated using the Cardiac and Comorbid Conditions Heart Failure score. Assessment of frailty using gait speed is simple and should be part of the clinical evaluation process.