TY - JOUR
T1 - Gait speed and 1-year mortality following cardiac surgery
T2 - A landmark analysis from the society of thoracic surgeons adult cardiac surgery database
AU - Afilalo, Jonathan
AU - Sharma, Abhinav
AU - Zhang, Shuaiqi
AU - Brennan, J. Matthew
AU - Edwards, Fred H.
AU - Mack, Michael J.
AU - McClurken, James B.
AU - Cleveland, Joseph C.
AU - Smith, Peter K.
AU - Shahian, David M.
AU - Peterson, Eric D.
AU - Alexander, Karen P.
N1 - Funding Information:
Dr Afilalo holds a Clinical Research Scholars Junior II Career Award from the Fonds de la Recherche en Santé duQuébec (FRSQ) and a New Investigator Award from the Canadian Institutes of Health Research. Dr Sharma is supported by the Alberta Innovates Health Solution Clinician Scientist Research Grant. The sponsors had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; in the preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Funding Information:
Dr Afilalo holds a Clinical Research Scholars Junior II Career Award from the Fonds de la Recherche en Santédu Québec (FRSQ) and a New Investigator Award from the Canadian Institutes of Health Research. Dr Sharma is supported by the Alberta Innovates Health Solution Clinician Scientist Research Grant. The sponsors had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; in the preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Publisher Copyright:
© 2018 The Authors.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Background-—In older adults undergoing cardiac surgery, prediction of downstream risk is critical. Our objective was to determine the association of 5-m gait speed with 1-year mortality and repeat hospitalization following cardiac surgery. Methods and Results-—In this prospective cohort of patients undergoing cardiac surgery at centers participating in the Society of Thoracic Surgeons Database with gait speed recorded, we examined all-cause mortality using a landmark analysis at 0 to 30, 30 to 365, and >365 days, as well as repeat hospitalization. The cohort consisted of 8287 patients (median age, 74 years; 32% females). At 1 year, survival was 90% in the slow (<0.83 m/s), 95% in the middle (0.83–1.00 m/s), and 97% in the fast (>1.00 m/s) gait speed tertiles, and risk of hospitalization was 45%, 33%, and 27%, respectively (both P<0.0001). After adjustment, gait speed remained predictive of mortality (hazard ratio, 2.16 per 0.1-m/s decrease in gait speed; 95% confidence interval, 1.59–2.93) and rehospitalization (hazard ratio, 1.71 per 0.1-m/s decrease in gait speed; 95% confidence interval, 1.45–2.0). In a landmark analysis, the effect of slow gait speed on mortality was most marked from 30 to 365 days after surgery, where each decline in 0.1 m/s of gait speed conferred a 2-fold increased risk of mortality. Conclusions-—Gait speed is a simple tool to screen for frailty and identify older adults at risk for adverse events in the early and midterm postoperative periods.
AB - Background-—In older adults undergoing cardiac surgery, prediction of downstream risk is critical. Our objective was to determine the association of 5-m gait speed with 1-year mortality and repeat hospitalization following cardiac surgery. Methods and Results-—In this prospective cohort of patients undergoing cardiac surgery at centers participating in the Society of Thoracic Surgeons Database with gait speed recorded, we examined all-cause mortality using a landmark analysis at 0 to 30, 30 to 365, and >365 days, as well as repeat hospitalization. The cohort consisted of 8287 patients (median age, 74 years; 32% females). At 1 year, survival was 90% in the slow (<0.83 m/s), 95% in the middle (0.83–1.00 m/s), and 97% in the fast (>1.00 m/s) gait speed tertiles, and risk of hospitalization was 45%, 33%, and 27%, respectively (both P<0.0001). After adjustment, gait speed remained predictive of mortality (hazard ratio, 2.16 per 0.1-m/s decrease in gait speed; 95% confidence interval, 1.59–2.93) and rehospitalization (hazard ratio, 1.71 per 0.1-m/s decrease in gait speed; 95% confidence interval, 1.45–2.0). In a landmark analysis, the effect of slow gait speed on mortality was most marked from 30 to 365 days after surgery, where each decline in 0.1 m/s of gait speed conferred a 2-fold increased risk of mortality. Conclusions-—Gait speed is a simple tool to screen for frailty and identify older adults at risk for adverse events in the early and midterm postoperative periods.
KW - Elderly
KW - Function
KW - Mortality
KW - Surgery
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U2 - 10.1161/JAHA.118.010139
DO - 10.1161/JAHA.118.010139
M3 - Article
C2 - 30571598
AN - SCOPUS:85058455365
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
SN - 2047-9980
IS - 23
M1 - e010139
ER -