Standardized gait speed ratio in elderly patients with heart failure

Aims Although aging is strongly associated with both heart failure and a decline in gait speed, a definition of slowness incorporating an age-related decline has yet to be developed. We aimed to define an event-driven cut-off for the relative decline in gait speed against age-adjusted reference values derived from the general population and evaluate its prognostic implications. Methods and results Standardized gait speed (SGS) was defined as the median gait speed stratified by age, sex, and height in 3777 elderly (age >= 65 years) individuals without a history of cardiovascular diseases (Tokyo Metropolitan Institute of Gerontology-Longitudinal Interdisciplinary Study on Aging: general population cohort). The mortality event-driven optimal cut-off of the SGS ratio (actual gait speed divided by the respective SGS) was defined using FRAGILE-HF cohort data and externally validated using Kitasato cohort data, comprising 1301 and 1247 hospitalized elderly patients with heart failure, respectively. Using FRAGILE-HF data, the optimal SGS ratio cut-off was determined as 0.527. In the Kitasato cohort, SGS ratio < 0.527 was associated with a higher 1 year [hazard ratio (HR): 1.70, 95% confidence interval (CI): 1.07-2.72, P = 0.024] and long-term (HR: 1.46, 95% CI: 1.05-2.02, P = 0.024) mortality rate, independent of pre-existing covariates. Conclusions Gait speed was significantly declined in patients with heart failure, even after taking age and sex-related decline into account. A SGS ratio of 0.527 is a validated cut-off for slowness independently associated with mortality in patients with heart failure age >= 65.