Gait Speed and 1‐Year Mortality Following Cardiac Surgery: A Landmark Analysis From the Society of Thoracic Surgeons Adult Cardiac Surgery Database

Afilalo, Jonathan; Sharma, Abhinav; Zhang, Shuaiqi; Brennan, James M.; Edwards, Fred H.; McClurken, James B.; Cleveland, Joseph C.; Smith, Peter K.; Shahian, David M.; Peterson, Eric D.; Alexander, Karen P.

doi:10.1161/jaha.118.010139

Cited by 46 publications

(39 citation statements)

References 31 publications

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“…29 There is a relation between low gait speed and increased mortality in elderly patients undergoing cardiac surgery. 30,31 In a study by Kamiya and colleagues gait speed was comparable to the 6MWT in a subgroup of patients undergoing cardiac surgery. 31 No studies have compared gait speed with 6MWT with regard to myocardial injury and mortality in patients undergoing non-cardiac surgery.…”

Section: The Literaturementioning

confidence: 95%

Added value of subjective assessed functional capacity before non-cardiac surgery in predicting postoperative myocardial injury

Marsman

Waes

Grobben

et al. 2020

European Journal of Preventive Cardiology

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Background Functional capacity is used as an indicator for cardiac testing before non-cardiac surgery and is often performed subjectively. However, the value of subjectively estimated functional capacity in predicting cardiac complications is under debate. We determined the predictive value of subjectively assessed functional capacity on postoperative cardiac complications and mortality. Design An observational cohort study in patients aged 60 years and over undergoing elective inpatient non-cardiac surgery in a tertiary referral hospital. Methods Subjective functional capacity was determined by anaesthesiologists. The primary outcome was postoperative myocardial injury. Secondary outcomes were postoperative inhospital myocardial infarction and one year mortality. Logistic regression analysis and area under the receiver operating curves were used to determine the added value of functional capacity. Results A total of 4879 patients was included; 824 (17%) patients had a poor subjective functional capacity. Postoperative myocardial injury occurred in 718 patients (15%). Poor functional capacity was associated with myocardial injury (relative risk (RR) 1.7, 95% confidence interval (CI) 1.5–2.0; P < 0.001), postoperative myocardial infarction (RR 2.9, 95% CI 1.9–4.2; P < 0.001) and one year mortality (RR 1.7, 95% CI 1.4–2.0; P < 0.001). After adjustment for other predictors, functional capacity was still a significant predictor for myocardial injury (odds ratio (OR) 1.3, 95% CI 1.0–1.7; P = 0.023), postoperative myocardial infarction (OR 2.0, 95% CI 1.3–3.0; P = 0.002) and one year mortality (OR 1.4, 95% CI 1.1–1.8; P = 0.003), but had no added value on top of other predictors. Conclusions Subjectively assessed functional capacity is a predictor of postoperative myocardial injury and death, but had no added value on top of other preoperative predictors.

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Section: The Literaturementioning

confidence: 95%

Added value of subjective assessed functional capacity before non-cardiac surgery in predicting postoperative myocardial injury

Marsman

Waes

Grobben

et al. 2020

European Journal of Preventive Cardiology

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“…The reliability was lower when using the first and second trials, the first and third or the three trials. Most of studies on gait used the average of three trials in various populations (e.g., healthy [ 50 , 79 ] or pathological [ 80 ]), but the number of trials necessary to obtain reliable measurements has been poorly investigated [ 28 , 81 ].…”

Section: Discussionmentioning

confidence: 99%

Foot-Worn Inertial Sensors Are Reliable to Assess Spatiotemporal Gait Parameters in Axial Spondyloarthritis under Single and Dual Task Walking in Axial Spondyloarthritis

Soulard

Vaillant

Balaguier

et al. 2020

Sensors

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The aim of this study was (1) to evaluate the relative and absolute reliability of gait parameters during walking in single- and dual-task conditions in patients with axial spondyloarthritis (axSpA), (2) to evaluate the absolute and relative reliability of dual task effects (DTE) parameters, and (3) to determine the number of trials required to ensure reliable gait assessment, in patients with axSpA. Twenty patients with axSpa performed a 10-m walk test in single- and dual-task conditions, three times for each condition. Spatiotemporal, symmetry, and DTE gait parameters were calculated from foot-worn inertial sensors. The relative reliability (intraclass correlation coefficients-ICC) and absolute reliability (standard error of measurement-SEM and minimum detectable change-MDC) were calculated for these parameters in each condition. Spatiotemporal gait parameters showed good to excellent reliability in both conditions (0.59 < ICC < 0.90). The reliability of symmetry and DTE parameters was low. ICC, SEM, and MDC were better when using the mean of the second and the third trials. Spatiotemporal gait parameters obtained from foot-worn inertial sensors assessed in patients with axSpA in single- and dual-task conditions are reliable. However, symmetry and DTE parameters seem less reliable and need to be interpreted with caution. Finally, better reliability of gait parameters was found when using the mean of the 2nd and the 3rd trials.

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“…They showed that gait speed had a prognostic value on 100-day mortality ( p = 0.005, HR 3.43) [ 38 ]. In the study of Afilalo et al, gait speed was studied for one-year mortality specifically following cardiac surgery [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Can usual gait speed be used as a prognostic factor for early palliative care identification in hospitalized older patients? A prospective study on two different wards

et al. 2020

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Background Timely palliative care in frail older persons remains challenging. Scales to identify older patients at risk of functional decline already exist. However, factors to predict short term mortality in older hospitalized patients are scarce. Methods In this prospective study, we recruited patients of 75 years and older at the department of cardiology and geriatrics. The usual gait speed measurement closest to discharge was chosen. We used the risk of dying within 1 year as parameter for starting palliative care. ROC curves were used to determine the best cut-off value of usual gait speed to predict one-year mortality. Time to event analyses were assessed by COX regression. Results On the acute geriatric ward (n = 60), patients were older and more frail (assessed by Katz and iADL) in comparison to patients on the cardiology ward (n = 82); one-year mortality was respectively 27 and 15% (p = 0.069). AUC on the acute geriatric ward was 0.748 (p = 0.006). The best cut-off value was 0.42 m/s with a sensitivity and specificity of 0.857 and 0.643. Slow walkers died earlier than faster walkers (HR 7.456, p = 0.011), after correction for age and sex. On the cardiology ward, AUC was 0.560 (p = 0.563); no significant association was found between usual gait speed and survival time. Conclusions Usual gait speed may be a valuable prognostic factor to identify patients at risk for one-year mortality on the acute geriatric ward but not on the cardiology ward.

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Gait Speed and 1‐Year Mortality Following Cardiac Surgery: A Landmark Analysis From the Society of Thoracic Surgeons Adult Cardiac Surgery Database

Cited by 46 publications

References 31 publications

Added value of subjective assessed functional capacity before non-cardiac surgery in predicting postoperative myocardial injury

Added value of subjective assessed functional capacity before non-cardiac surgery in predicting postoperative myocardial injury

Foot-Worn Inertial Sensors Are Reliable to Assess Spatiotemporal Gait Parameters in Axial Spondyloarthritis under Single and Dual Task Walking in Axial Spondyloarthritis

Can usual gait speed be used as a prognostic factor for early palliative care identification in hospitalized older patients? A prospective study on two different wards

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