Giovanni Pulignano1, Donatella Del Sindaco2, Andrea Di Lenarda3, Gianfranco Alunni4, Michele Senni5, Luigi Tarantini6, Giovanni Cioffi7, Maria Denitza Tinti8, Giulia Barbati3, Giovanni Minardi8, Massimo Uguccioni8. 1. Heart Failure Clinic, Division of Cardiology/C.C.U., San Camillo Hospital, Rome, Italy. Electronic address: gipulig@yahoo.it. 2. Cardiology Unit, Nuovo Regina Margherita Hospital, Rome, Italy. 3. Cardiovascular Center and University of Trieste, Trieste, Italy. 4. Cardiology Unit, S. Maria della Misericordia Hospital, Perugia, Italy. 5. Cardiology Unit, S. Giovanni XXIII Hospital, Bergamo, Italy. 6. Heart Failure Clinic, Division of Cardiology, San Martino Hospital, Belluno, Italy. 7. Division of Cardiology, Villa Bianca Hospital, Trento, Italy. 8. Heart Failure Clinic, Division of Cardiology/C.C.U., San Camillo Hospital, Rome, Italy.
Abstract
OBJECTIVES: 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.
OBJECTIVES: 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.
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