Slow Gait Speed and Cardiac Rehabilitation Participation in Older Adults After Acute Myocardial Infarction

Background Lack of participation in cardiac rehabilitation (CR) and slow gait speed have both been associated with poor long‐term outcomes in older adults after acute myocardial infarction (AMI). Whether the effect of CR participation on outcomes after AMI differs by gait speed is unknown. Methods a...

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Veröffentlicht in:	Journal of the American Heart Association Jg. 7; H. 5
Hauptverfasser:	Flint, Kelsey, Kennedy, Kevin, Arnold, Suzanne V., Dodson, John A., Cresci, Sharon, Alexander, Karen P.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	England John Wiley and Sons Inc 06.03.2018 Wiley
Schlagworte:	acute myocardial infarction Age Factors Aged cardiac rehabilitation Cardiac Rehabilitation - adverse effects Cardiac Rehabilitation - methods Cardiac Rehabilitation - mortality Clinical Decision-Making Disability Evaluation Exercise Therapy - adverse effects Exercise Therapy - methods Exercise Therapy - mortality Female frailty function gait speed Humans Male Myocardial Infarction - diagnosis Myocardial Infarction - mortality Myocardial Infarction - physiopathology Myocardial Infarction - rehabilitation Original Research Prospective Studies Recovery of Function Registries Time Factors Treatment Outcome United States Walk Test Walking Speed United States gait speed frailty acute myocardial infarction cardiac rehabilitation function
ISSN:	2047-9980, 2047-9980
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Abstract	Background Lack of participation in cardiac rehabilitation (CR) and slow gait speed have both been associated with poor long‐term outcomes in older adults after acute myocardial infarction (AMI). Whether the effect of CR participation on outcomes after AMI differs by gait speed is unknown. Methods and Results We examined the association between gait speed and CR participation at 1 month after discharge after AMI, and death and disability at 1 year, in 329 patients aged ≥65 years enrolled in the TRIUMPH (Translational Research Investigating Underlying Disparities in Recovery From Acute Myocardial Infarction: Patients' Health Status) registry. Among these patients, 177 (53.7%) had slow gait speed (<0.8 m/s) and 109 (33.1%) participated in CR. Patients with slow gait speed were less likely to participate in CR compared with patients with normal gait speed (27.1% versus 40.1%; P=0.012). In unadjusted analysis, CR participants with normal gait speed had the lowest rate of death or disability at 1 year (9.3%), compared with those with slow gait speed and no CR participation (43.2%). After adjustment for cardiovascular risk factors and cognitive impairment, both slow gait speed (odds ratio, 2.30; 95% confidence interval, 1.30–4.06) and non‐CR participation (odds ratio, 2.34; 95 confidence interval, 1.22–4.48) were independently associated with death or disability at 1 year. The effect of CR on the primary outcome did not differ by gait speed (P=0.70). Conclusions CR participation is associated with reduced risk for death or disability after AMI. The beneficial effect of CR participation does not differ by gait speed, suggesting that slow gait speed alone should not preclude referral to CR for older adults after AMI.
AbstractList	Lack of participation in cardiac rehabilitation (CR) and slow gait speed have both been associated with poor long-term outcomes in older adults after acute myocardial infarction (AMI). Whether the effect of CR participation on outcomes after AMI differs by gait speed is unknown. We examined the association between gait speed and CR participation at 1 month after discharge after AMI, and death and disability at 1 year, in 329 patients aged ≥65 years enrolled in the TRIUMPH (Translational Research Investigating Underlying Disparities in Recovery From Acute Myocardial Infarction: Patients' Health Status) registry. Among these patients, 177 (53.7%) had slow gait speed (<0.8 m/s) and 109 (33.1%) participated in CR. Patients with slow gait speed were less likely to participate in CR compared with patients with normal gait speed (27.1% versus 40.1%; =0.012). In unadjusted analysis, CR participants with normal gait speed had the lowest rate of death or disability at 1 year (9.3%), compared with those with slow gait speed and no CR participation (43.2%). After adjustment for cardiovascular risk factors and cognitive impairment, both slow gait speed (odds ratio, 2.30; 95% confidence interval, 1.30-4.06) and non-CR participation (odds ratio, 2.34; 95 confidence interval, 1.22-4.48) were independently associated with death or disability at 1 year. The effect of CR on the primary outcome did not differ by gait speed ( =0.70). CR participation is associated with reduced risk for death or disability after AMI. The beneficial effect of CR participation does not differ by gait speed, suggesting that slow gait speed alone should not preclude referral to CR for older adults after AMI. BackgroundLack of participation in cardiac rehabilitation (CR) and slow gait speed have both been associated with poor long‐term outcomes in older adults after acute myocardial infarction (AMI). Whether the effect of CR participation on outcomes after AMI differs by gait speed is unknown. Methods and ResultsWe examined the association between gait speed and CR participation at 1 month after discharge after AMI, and death and disability at 1 year, in 329 patients aged ≥65 years enrolled in the TRIUMPH (Translational Research Investigating Underlying Disparities in Recovery From Acute Myocardial Infarction: Patients' Health Status) registry. Among these patients, 177 (53.7%) had slow gait speed (<0.8 m/s) and 109 (33.1%) participated in CR. Patients with slow gait speed were less likely to participate in CR compared with patients with normal gait speed (27.1% versus 40.1%; P=0.012). In unadjusted analysis, CR participants with normal gait speed had the lowest rate of death or disability at 1 year (9.3%), compared with those with slow gait speed and no CR participation (43.2%). After adjustment for cardiovascular risk factors and cognitive impairment, both slow gait speed (odds ratio, 2.30; 95% confidence interval, 1.30–4.06) and non‐CR participation (odds ratio, 2.34; 95 confidence interval, 1.22–4.48) were independently associated with death or disability at 1 year. The effect of CR on the primary outcome did not differ by gait speed (P=0.70). ConclusionsCR participation is associated with reduced risk for death or disability after AMI. The beneficial effect of CR participation does not differ by gait speed, suggesting that slow gait speed alone should not preclude referral to CR for older adults after AMI. Background Lack of participation in cardiac rehabilitation (CR) and slow gait speed have both been associated with poor long‐term outcomes in older adults after acute myocardial infarction (AMI). Whether the effect of CR participation on outcomes after AMI differs by gait speed is unknown. Methods and Results We examined the association between gait speed and CR participation at 1 month after discharge after AMI, and death and disability at 1 year, in 329 patients aged ≥65 years enrolled in the TRIUMPH (Translational Research Investigating Underlying Disparities in Recovery From Acute Myocardial Infarction: Patients' Health Status) registry. Among these patients, 177 (53.7%) had slow gait speed (<0.8 m/s) and 109 (33.1%) participated in CR. Patients with slow gait speed were less likely to participate in CR compared with patients with normal gait speed (27.1% versus 40.1%; P=0.012). In unadjusted analysis, CR participants with normal gait speed had the lowest rate of death or disability at 1 year (9.3%), compared with those with slow gait speed and no CR participation (43.2%). After adjustment for cardiovascular risk factors and cognitive impairment, both slow gait speed (odds ratio, 2.30; 95% confidence interval, 1.30–4.06) and non‐CR participation (odds ratio, 2.34; 95 confidence interval, 1.22–4.48) were independently associated with death or disability at 1 year. The effect of CR on the primary outcome did not differ by gait speed (P=0.70). Conclusions CR participation is associated with reduced risk for death or disability after AMI. The beneficial effect of CR participation does not differ by gait speed, suggesting that slow gait speed alone should not preclude referral to CR for older adults after AMI. Lack of participation in cardiac rehabilitation (CR) and slow gait speed have both been associated with poor long-term outcomes in older adults after acute myocardial infarction (AMI). Whether the effect of CR participation on outcomes after AMI differs by gait speed is unknown.BACKGROUNDLack of participation in cardiac rehabilitation (CR) and slow gait speed have both been associated with poor long-term outcomes in older adults after acute myocardial infarction (AMI). Whether the effect of CR participation on outcomes after AMI differs by gait speed is unknown.We examined the association between gait speed and CR participation at 1 month after discharge after AMI, and death and disability at 1 year, in 329 patients aged ≥65 years enrolled in the TRIUMPH (Translational Research Investigating Underlying Disparities in Recovery From Acute Myocardial Infarction: Patients' Health Status) registry. Among these patients, 177 (53.7%) had slow gait speed (<0.8 m/s) and 109 (33.1%) participated in CR. Patients with slow gait speed were less likely to participate in CR compared with patients with normal gait speed (27.1% versus 40.1%; P=0.012). In unadjusted analysis, CR participants with normal gait speed had the lowest rate of death or disability at 1 year (9.3%), compared with those with slow gait speed and no CR participation (43.2%). After adjustment for cardiovascular risk factors and cognitive impairment, both slow gait speed (odds ratio, 2.30; 95% confidence interval, 1.30-4.06) and non-CR participation (odds ratio, 2.34; 95 confidence interval, 1.22-4.48) were independently associated with death or disability at 1 year. The effect of CR on the primary outcome did not differ by gait speed (P=0.70).METHODS AND RESULTSWe examined the association between gait speed and CR participation at 1 month after discharge after AMI, and death and disability at 1 year, in 329 patients aged ≥65 years enrolled in the TRIUMPH (Translational Research Investigating Underlying Disparities in Recovery From Acute Myocardial Infarction: Patients' Health Status) registry. Among these patients, 177 (53.7%) had slow gait speed (<0.8 m/s) and 109 (33.1%) participated in CR. Patients with slow gait speed were less likely to participate in CR compared with patients with normal gait speed (27.1% versus 40.1%; P=0.012). In unadjusted analysis, CR participants with normal gait speed had the lowest rate of death or disability at 1 year (9.3%), compared with those with slow gait speed and no CR participation (43.2%). After adjustment for cardiovascular risk factors and cognitive impairment, both slow gait speed (odds ratio, 2.30; 95% confidence interval, 1.30-4.06) and non-CR participation (odds ratio, 2.34; 95 confidence interval, 1.22-4.48) were independently associated with death or disability at 1 year. The effect of CR on the primary outcome did not differ by gait speed (P=0.70).CR participation is associated with reduced risk for death or disability after AMI. The beneficial effect of CR participation does not differ by gait speed, suggesting that slow gait speed alone should not preclude referral to CR for older adults after AMI.CONCLUSIONSCR participation is associated with reduced risk for death or disability after AMI. The beneficial effect of CR participation does not differ by gait speed, suggesting that slow gait speed alone should not preclude referral to CR for older adults after AMI.
Author	Cresci, Sharon Alexander, Karen P. Kennedy, Kevin Arnold, Suzanne V. Flint, Kelsey Dodson, John A.
AuthorAffiliation	4 University of Missouri–Kansas City Kansas City MO 2 Colorado Cardiovascular Outcomes Research Aurora CO 6 Division of Healthcare Delivery Science Department of Population Health New York University School of Medicine New York NY 8 Division of Cardiology Duke Clinical Research Institute Duke University Medical Center Durham NC 7 Cardiovascular Division Washington University in St Louis MO 5 Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY 1 Division of Cardiology University of Colorado Aurora CO 3 Saint Luke's Mid America Heart Institute Saint Luke's Health System Kansas City MO
AuthorAffiliation_xml	– name: 4 University of Missouri–Kansas City Kansas City MO – name: 5 Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY – name: 1 Division of Cardiology University of Colorado Aurora CO – name: 6 Division of Healthcare Delivery Science Department of Population Health New York University School of Medicine New York NY – name: 3 Saint Luke's Mid America Heart Institute Saint Luke's Health System Kansas City MO – name: 2 Colorado Cardiovascular Outcomes Research Aurora CO – name: 8 Division of Cardiology Duke Clinical Research Institute Duke University Medical Center Durham NC – name: 7 Cardiovascular Division Washington University in St Louis MO
Author_xml	– sequence: 1 givenname: Kelsey surname: Flint fullname: Flint, Kelsey email: kelsey.flint@ucdenver.edu organization: Colorado Cardiovascular Outcomes Research – sequence: 2 givenname: Kevin surname: Kennedy fullname: Kennedy, Kevin organization: Saint Luke's Health System – sequence: 3 givenname: Suzanne V. surname: Arnold fullname: Arnold, Suzanne V. organization: University of Missouri–Kansas City – sequence: 4 givenname: John A. surname: Dodson fullname: Dodson, John A. organization: New York University School of Medicine – sequence: 5 givenname: Sharon surname: Cresci fullname: Cresci, Sharon organization: Washington University in St Louis – sequence: 6 givenname: Karen P. surname: Alexander fullname: Alexander, Karen P. organization: Duke University Medical Center
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/29478024$$D View this record in MEDLINE/PubMed
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Keywords	gait speed frailty acute myocardial infarction cardiac rehabilitation function
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Snippet	Background Lack of participation in cardiac rehabilitation (CR) and slow gait speed have both been associated with poor long‐term outcomes in older adults... Lack of participation in cardiac rehabilitation (CR) and slow gait speed have both been associated with poor long-term outcomes in older adults after acute... BackgroundLack of participation in cardiac rehabilitation (CR) and slow gait speed have both been associated with poor long‐term outcomes in older adults after...
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SubjectTerms	acute myocardial infarction Age Factors Aged cardiac rehabilitation Cardiac Rehabilitation - adverse effects Cardiac Rehabilitation - methods Cardiac Rehabilitation - mortality Clinical Decision-Making Disability Evaluation Exercise Therapy - adverse effects Exercise Therapy - methods Exercise Therapy - mortality Female frailty function gait speed Humans Male Myocardial Infarction - diagnosis Myocardial Infarction - mortality Myocardial Infarction - physiopathology Myocardial Infarction - rehabilitation Original Research Prospective Studies Recovery of Function Registries Time Factors Treatment Outcome United States Walk Test Walking Speed
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Title	Slow Gait Speed and Cardiac Rehabilitation Participation in Older Adults After Acute Myocardial Infarction
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