Novel Gait Speed Cut-Off Values Associated With Prognosis in Older Patients With Heart Failure

Area of Science:

• Gerontology
• Cardiology
• Physical Therapy

Background:

• Gait speed is a key prognostic indicator in heart failure (HF) and a target for intervention.
• A previously proposed gait speed cutoff of 0.98 m/s may not capture the full prognostic spectrum in older HF patients.
• Identifying multiple gait speed thresholds can facilitate stepwise rehabilitation goals for diverse older HF populations.

Purpose of the Study:

• To determine if additional prognostic gait speed cutoffs exist at discharge in older heart failure patients.
• To establish new, evidence-based gait speed thresholds for improved risk stratification.
• To inform the development of tailored physiotherapy interventions for heart failure management.

Main Methods:

• Secondary analysis of the J-Proof HF trial involving 7326 older adults (≥65 years) with confirmed heart failure.
• Randomized cohort into derivation (60%) and validation (40%) groups for robust analysis.
• Survival classification and regression tree (CART) analysis to identify gait speed cutoffs, with primary outcome of all-cause death or HF readmission within 1 year.

Main Results:

• Three significant prognostic gait speed cutoffs were identified: <0.39 m/s, <0.69 m/s, and <1.00 m/s, creating four distinct patient categories.
• Slower gait speed categories were associated with older age, increased comorbidities, and diminished physical function.
• Gait speed category independently predicted adverse outcomes, demonstrating its continued prognostic value (HR 1.21, 95% CI 1.13-1.30).

Conclusions:

• New prognostic gait speed cutoffs (<0.39, <0.69, <1.00 m/s) were established for older heart failure patients.
• These thresholds offer a more nuanced approach to risk assessment and goal setting in HF rehabilitation.
• Individualized physiotherapy goals can be set based on these validated gait speed categories to optimize patient mobility and outcomes.