Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery

The purpose of this study was to test the value of gait speed, a clinical marker for frailty, to improve the prediction of mortality and major morbidity in elderly patients undergoing cardiac surgery. It is increasingly difficult to predict the elderly patient's risk posed by cardiac surgery be...

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Published in:	Journal of the American College of Cardiology Vol. 56; no. 20; p. 1668
Main Authors:	Afilalo, Jonathan, Eisenberg, Mark J, Morin, Jean-François, Bergman, Howard, Monette, Johanne, Noiseux, Nicolas, Perrault, Louis P, Alexander, Karen P, Langlois, Yves, Dendukuri, Nandini, Chamoun, Patrick, Kasparian, Georges, Robichaud, Sophie, Gharacholou, S Michael, Boivin, Jean-François
Format:	Journal Article
Language:	English
Published:	United States 09.11.2010
Subjects:	Aged Cardiac Surgical Procedures - methods Cardiac Surgical Procedures - mortality Confidence Intervals Exercise Test Female Follow-Up Studies Gait - physiology Heart Diseases - epidemiology Heart Diseases - surgery Humans Male Morbidity - trends Odds Ratio Prognosis Prospective Studies Quebec - epidemiology Survival Rate - trends United States - epidemiology United States Quebec
ISSN:	1558-3597, 1558-3597
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Abstract	The purpose of this study was to test the value of gait speed, a clinical marker for frailty, to improve the prediction of mortality and major morbidity in elderly patients undergoing cardiac surgery. It is increasingly difficult to predict the elderly patient's risk posed by cardiac surgery because existing risk assessment tools are incomplete. A multicenter prospective cohort of elderly patients undergoing cardiac surgery was assembled at 4 tertiary care hospitals between 2008 and 2009. Patients were eligible if they were 70 years of age or older and were scheduled for coronary artery bypass and/or valve replacement or repair. The primary predictor was slow gait speed, defined as a time taken to walk 5 m of ≥ 6 s. The primary end point was a composite of in-hospital post-operative mortality or major morbidity. The cohort consisted of 131 patients with a mean age of 75.8 ± 4.4 years; 34% were female patients. Sixty patients (46%) were classified as slow walkers before cardiac surgery. Slow walkers were more likely to be female (43% vs. 25%, p = 0.03) and diabetic (50% vs. 28%, p = 0.01). Thirty patients (23%) experienced the primary composite end point of mortality or major morbidity after cardiac surgery. Slow gait speed was an independent predictor of the composite end point after adjusting for the Society of Thoracic Surgeons risk score (odds ratio: 3.05; 95% confidence interval: 1.23 to 7.54). Gait speed is a simple and effective test that may identify a subset of vulnerable elderly patients at incrementally higher risk of mortality and major morbidity after cardiac surgery.
AbstractList	The purpose of this study was to test the value of gait speed, a clinical marker for frailty, to improve the prediction of mortality and major morbidity in elderly patients undergoing cardiac surgery.OBJECTIVESThe purpose of this study was to test the value of gait speed, a clinical marker for frailty, to improve the prediction of mortality and major morbidity in elderly patients undergoing cardiac surgery.It is increasingly difficult to predict the elderly patient's risk posed by cardiac surgery because existing risk assessment tools are incomplete.BACKGROUNDIt is increasingly difficult to predict the elderly patient's risk posed by cardiac surgery because existing risk assessment tools are incomplete.A multicenter prospective cohort of elderly patients undergoing cardiac surgery was assembled at 4 tertiary care hospitals between 2008 and 2009. Patients were eligible if they were 70 years of age or older and were scheduled for coronary artery bypass and/or valve replacement or repair. The primary predictor was slow gait speed, defined as a time taken to walk 5 m of ≥ 6 s. The primary end point was a composite of in-hospital post-operative mortality or major morbidity.METHODSA multicenter prospective cohort of elderly patients undergoing cardiac surgery was assembled at 4 tertiary care hospitals between 2008 and 2009. Patients were eligible if they were 70 years of age or older and were scheduled for coronary artery bypass and/or valve replacement or repair. The primary predictor was slow gait speed, defined as a time taken to walk 5 m of ≥ 6 s. The primary end point was a composite of in-hospital post-operative mortality or major morbidity.The cohort consisted of 131 patients with a mean age of 75.8 ± 4.4 years; 34% were female patients. Sixty patients (46%) were classified as slow walkers before cardiac surgery. Slow walkers were more likely to be female (43% vs. 25%, p = 0.03) and diabetic (50% vs. 28%, p = 0.01). Thirty patients (23%) experienced the primary composite end point of mortality or major morbidity after cardiac surgery. Slow gait speed was an independent predictor of the composite end point after adjusting for the Society of Thoracic Surgeons risk score (odds ratio: 3.05; 95% confidence interval: 1.23 to 7.54).RESULTSThe cohort consisted of 131 patients with a mean age of 75.8 ± 4.4 years; 34% were female patients. Sixty patients (46%) were classified as slow walkers before cardiac surgery. Slow walkers were more likely to be female (43% vs. 25%, p = 0.03) and diabetic (50% vs. 28%, p = 0.01). Thirty patients (23%) experienced the primary composite end point of mortality or major morbidity after cardiac surgery. Slow gait speed was an independent predictor of the composite end point after adjusting for the Society of Thoracic Surgeons risk score (odds ratio: 3.05; 95% confidence interval: 1.23 to 7.54).Gait speed is a simple and effective test that may identify a subset of vulnerable elderly patients at incrementally higher risk of mortality and major morbidity after cardiac surgery.CONCLUSIONSGait speed is a simple and effective test that may identify a subset of vulnerable elderly patients at incrementally higher risk of mortality and major morbidity after cardiac surgery. The purpose of this study was to test the value of gait speed, a clinical marker for frailty, to improve the prediction of mortality and major morbidity in elderly patients undergoing cardiac surgery. It is increasingly difficult to predict the elderly patient's risk posed by cardiac surgery because existing risk assessment tools are incomplete. A multicenter prospective cohort of elderly patients undergoing cardiac surgery was assembled at 4 tertiary care hospitals between 2008 and 2009. Patients were eligible if they were 70 years of age or older and were scheduled for coronary artery bypass and/or valve replacement or repair. The primary predictor was slow gait speed, defined as a time taken to walk 5 m of ≥ 6 s. The primary end point was a composite of in-hospital post-operative mortality or major morbidity. The cohort consisted of 131 patients with a mean age of 75.8 ± 4.4 years; 34% were female patients. Sixty patients (46%) were classified as slow walkers before cardiac surgery. Slow walkers were more likely to be female (43% vs. 25%, p = 0.03) and diabetic (50% vs. 28%, p = 0.01). Thirty patients (23%) experienced the primary composite end point of mortality or major morbidity after cardiac surgery. Slow gait speed was an independent predictor of the composite end point after adjusting for the Society of Thoracic Surgeons risk score (odds ratio: 3.05; 95% confidence interval: 1.23 to 7.54). Gait speed is a simple and effective test that may identify a subset of vulnerable elderly patients at incrementally higher risk of mortality and major morbidity after cardiac surgery.
Author	Chamoun, Patrick Afilalo, Jonathan Perrault, Louis P Monette, Johanne Alexander, Karen P Dendukuri, Nandini Kasparian, Georges Bergman, Howard Noiseux, Nicolas Langlois, Yves Gharacholou, S Michael Boivin, Jean-François Eisenberg, Mark J Robichaud, Sophie Morin, Jean-François
Author_xml	– sequence: 1 givenname: Jonathan surname: Afilalo fullname: Afilalo, Jonathan email: jonathan@afilalo.com organization: Division of Cardiology, Department of Medicine, SMBD-Jewish General Hospital, McGill University, Montreal, Quebec, Canada. jonathan@afilalo.com – sequence: 2 givenname: Mark J surname: Eisenberg fullname: Eisenberg, Mark J – sequence: 3 givenname: Jean-François surname: Morin fullname: Morin, Jean-François – sequence: 4 givenname: Howard surname: Bergman fullname: Bergman, Howard – sequence: 5 givenname: Johanne surname: Monette fullname: Monette, Johanne – sequence: 6 givenname: Nicolas surname: Noiseux fullname: Noiseux, Nicolas – sequence: 7 givenname: Louis P surname: Perrault fullname: Perrault, Louis P – sequence: 8 givenname: Karen P surname: Alexander fullname: Alexander, Karen P – sequence: 9 givenname: Yves surname: Langlois fullname: Langlois, Yves – sequence: 10 givenname: Nandini surname: Dendukuri fullname: Dendukuri, Nandini – sequence: 11 givenname: Patrick surname: Chamoun fullname: Chamoun, Patrick – sequence: 12 givenname: Georges surname: Kasparian fullname: Kasparian, Georges – sequence: 13 givenname: Sophie surname: Robichaud fullname: Robichaud, Sophie – sequence: 14 givenname: S Michael surname: Gharacholou fullname: Gharacholou, S Michael – sequence: 15 givenname: Jean-François surname: Boivin fullname: Boivin, Jean-François
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/21050978$$D View this record in MEDLINE/PubMed
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References	21050979 - J Am Coll Cardiol. 2010 Nov 9;56(20):1677-8 21816319 - J Am Coll Cardiol. 2011 Aug 9;58(7):776; author reply 777
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SubjectTerms	Aged Cardiac Surgical Procedures - methods Cardiac Surgical Procedures - mortality Confidence Intervals Exercise Test Female Follow-Up Studies Gait - physiology Heart Diseases - epidemiology Heart Diseases - surgery Humans Male Morbidity - trends Odds Ratio Prognosis Prospective Studies Quebec - epidemiology Survival Rate - trends United States - epidemiology
Title	Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery
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