Elsevier

JACC: Heart Failure

Volume 4, Issue 4, April 2016, Pages 289-298
JACC: Heart Failure

Mini-Focus Issue: Risk Prediction and Prognosis in Heart Failure
Incremental Value of Gait Speed in Predicting Prognosis of Older Adults With Heart Failure: Insights From the IMAGE-HF Study

https://doi.org/10.1016/j.jchf.2015.12.017Get rights and content
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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.

Key Words

elderly
gait speed
heart failure
hospitalization
prognosis

Abbreviations and Acronyms

AUC
area under the curve
HF
heart failure
LVEF
left ventricular ejection fraction
MMSE
Mini-Mental State Examination
NRI
net reclassification improvement
3C-HF
Cardiac and Comorbid Conditions Heart Failure

Cited by (0)

This study was supported in part by the nonprofit organization ADRIANO (Italian Association for Research on Cardiac Disease in Older Patients) (Program AD-IMAGE-HF 003-2006).The authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.