Standardized gait speed ratio in elderly patients with heart failure

Abstract

Aims: Although aging is strongly associated with both heart failure and a decline in gait speed, a definition of slowness incorporating an age-related decline has yet to be developed. We aimed to define an event-driven cut-off for the relative decline in gait speed against age-adjusted reference values derived from the general population and evaluate its prognostic implications. Methods and results: Standardized gait speed (SGS) was defined as the median gait speed stratified by age, sex, and height in 3777 elderly (age ≥ 65 years) individuals without a history of cardiovascular diseases (Tokyo Metropolitan Institute of Gerontology-Longitudinal Interdisciplinary Study on Aging: general population cohort). The mortality event-driven optimal cut-off of the SGS ratio (actual gait speed divided by the respective SGS) was defined using FRAGILE-HF cohort data and externally validated using Kitasato cohort data, comprising 1301 and 1247 hospitalized elderly patients with heart failure, respectively. Using FRAGILE-HF data, the optimal SGS ratio cut-off was determined as 0.527. In the Kitasato cohort, SGS ratio < 0.527 was associated with a higher 1 year [hazard ratio (HR): 1.70, 95% confidence interval (CI): 1.07–2.72, P = 0.024] and long-term (HR: 1.46, 95% CI: 1.05–2.02, P = 0.024) mortality rate, independent of pre-existing covariates. Conclusions: Gait speed was significantly declined in patients with heart failure, even after taking age and sex-related decline into account. A SGS ratio of 0.527 is a validated cut-off for slowness independently associated with mortality in patients with heart failure age ≥65.