Research from ESC Heart Failure shows a slower standardized gait speed in older adults with heart failure.
According to the authors, the study is the first to show that gait speed in older adults with HF significantly declined compared with that in the general population, separate from slowness that occurs due to age.
Most prior research defined slowness using a single cut-off value derived from the general population, with no age-specific cut-offs proposed. “As the heart failure population is highly saturated with elderly patients, it is unclear whether older age or heart failure itself contributes the substantial number of patients with heart failure with low gait speed,” the study said.
Data From 3 Studies Examined
The study combined data from 3 different cohorts to determine an event-driven cut-off for the relative decline in gait speed. After excluding patients with a history of cardiovascular disease or missing data, 3777 older adults from the Tokyo Metropolitan Institute of Gerontology-Longitudinal Interdisciplinary Study on Aging (TMIG-LISA) cohort were used to define the standardized gait speed (SGS), which was stratified according to age, sex, and height.
Additionally, 1301 patients from the FRAGILE-HF cohort and 1247 patients from the Kitasato cohort in the same age demographic were used to derive and externally validate, respectively, the SGS ratio cut-off.
The median SGS ratio was slightly, but significantly, higher in the Kitasato cohort (0.74) than the FRAGILE-HF cohort (0.65). In the Kitasato cohort, SGS ratio < 0.527 was associated with a higher 1 year (HR, 1.70; 95% CI, 1.07-2.72, P = 0.024) and long-term (HR, 1.46, 95% CI, 1.05-2.02, P = .024) mortality rate, independent of pre-existing covariates. In both cohorts, the SGS ratio decreased with aging and gait speed declined by 35% to 40%.
Independent from age- and gender-related decline, SGS was observed to be slower in patients age 65 years and older with HF across the 3 separate studies. The study declared a SGS ratio of .527 as a valid cut-off for slowness independently associated with mortality in patients with HF in this age demographic.
“Referring to disease-specific and patient-specific reference values for gait speed would enable healthcare providers to estimate the future risk of adverse events in individual patients with heart failure in clinical practice,” the study said. “This is clinically relevant, as the slowness threshold cannot be the same for a 65-year-old male and a 90-year-old female, which is clearly supported by the present data.” The study also states that future studies should clarify whether interventions increasing gait speed subsequently improve the prognosis.
Ozawa T, Yamashita M, Seino S, et al. Standardized gait speed ratio in elderly patients with heart failure. ESC Heart Fail. Published online July 10, 2021. doi:10.1002/ehf2.13392