Slow Gait Speed and Risk of Mortality or Hospital Readmission After Myocardial Infarction in the Translational Research Investigating Underlying Disparities in Recovery from Acute Myocardial Infarction: Patients' Health Status Registry

Abstract

Objectives: To determine the prognostic value of slow gait in predicting outcomes 1 year after acute myocardial infarction (AMI).

Design: Observational cohort with longitudinal follow-up.

Setting: Twenty-four U.S. hospitals participating in the Translational Research Investigating Underlying disparities in recovery from acute Myocardial infarction: Patients' Health status Registry.

Participants: Older adults (≥65) with in-home gait assessment 1 month after AMI (N = 338).

Measurements: Baseline characteristics and 1-year mortality or hospital readmission adjusted using Cox proportional hazards regression in older adults with slow (<0.8 m/s) versus preserved (≥0.8 m/s) gait speed.

Results: Slow gait was present in 181 participants (53.6%). Those with slow gait were older, more likely to be female and nonwhite, and had a higher prevalence of heart failure and diabetes mellitus. They were also more likely to die or be readmitted to the hospital within 1 year than those with preserved gait (35.4% vs 18.5%, log-rank P = .006). This association remained significant after adjusting for age, sex, and race (slow vs preserved gait hazard ratio (HR) = 1.76, 95% confidence interval (CI)=1.08-2.87, P = .02) but was no longer significant after adding clinical factors (HR = 1.23, 95% CI=0.74-2.04, P = .43).

Conclusion: Slow gait, a marker of frailty, is common 1 month after AMI in older adults and is associated with nearly twice the risk of dying or hospital readmission at 1 year. Understanding its prognostic importance independent of comorbidities and whether routine testing of gait speed can improve care requires further investigation.

Keywords: coronary artery disease; frailty; older adults; outcomes.