Gait Speed and Dependence in Activities of Daily Living in Older Adults With Severe Aortic Stenosis

Abstract

Background In the transcatheter aortic valve replacement era, characterization of functional status in older adults with aortic stenosis (AS) is essential. Gait speed (GS) is emerging as a marker of frailty and predictor of outcomes in older adults undergoing cardiovascular intervention. The objective of this study was to delineate the prevalence of slow GS, evaluate the association of GS with factors used in standard cardiovascular assessments, and evaluate the association of GS with dependence in activities of daily living (ADLs) in older adults with AS. Hypothesis We hypothesized that gait speed would not be associated with clinical factors, but would be associated with ADLs. Methods We evaluated GS, ADLs dependence, and Society of Thoracic Surgery score along with clinical and functional assessments in 102 older adults with AS being evaluated for transcatheter valve. Gait speed <0.5 m/s was considered slow, and GS ≥0.5 m/s was considered preserved. We assessed the association of covariates with GS as well as with ADLs dependence. Results Median GS was 0.37 m/s (interquartile range, 0.0–0.65 m/s). Sixty-four (63%) subjects had slow GS. Of commonly employed clinical covariates, only prior coronary intervention and serum albumin were weakly associated with GS. However, GS was independently associated with ADLs dependence (Odds ratio: 1.52 [1.21–1.91] for every 0.1 m/s decrease in GS; P = 0.0003). Conclusions Although the prevalence of slow GS in a population of elderly patients with severe AS being screened for transcatheter valve was high, there were only weak associations between GS and other risk stratifying tools. The strong association between GS and dependent functional status suggests that assessment of gait speed is a useful, objectively measurable, risk stratification tool in this population.

Relation Between Six-Minute Walk Test Performance and Outcomes After Transcatheter Aortic Valve Implantation (from the PARTNER Trial)

“…26–28 Furthermore, frailty is highly prevalent and emerging as an important predictor of outcomes in the TAVI population. 29,30 In this population, the prognostic value of 6MWTD may be derived from the association of baseline 6MWTD with impaired cardiopulmonary reserve or as a marker of multisystem impairment and frailty or both. Future studies are needed to attempt to distinguish between these 2 overlapping syndromes in older adults with AS.…”

Frailty Assessment in the Cardiovascular Care of Older Adults

“…Green et al (70,71) presented the experience at Columbia University and surprisingly showed that frailty was predictive of 1-year mortality (17% if frail vs. 7% if not frail; HR: 3.5) but not the composite of 30-day mortality or morbidity. The lack of 30-day event prediction was attributed to “adequacy of the standard selection process,” although it should be noted that there was no systematic frailty assessment on patients who had been screened out to substantiate the adequacy of the selection process and the absolute number of events was low.…”

Outcomes of Treatment of Nonagenarians With Severe Aortic Stenosis

“…A serum albumin value of less than 3.5 mg/dL was considered low. Gait speed was measured by having qualified patients walk 5 meters (16.4 feet) in a designated, well-lit, open hallway at a "comfortable pace" as per the STS database guidelines [10]. If needed, patients were allowed to use a cane, walker, and oxygen support.…”