title: Impact of gait speed and instrumental activities of daily living on all-cause mortality in adults ≥65 years with heart failure.
abstract: Mobility and function are important predictors of survival. However, their combined impact on mortality in adults ≥65 years with heart failure (HF) is not well understood. This study examined the role of gait speed and instrumental activities of daily living (IADL) in all-cause mortality in a cohort of 1,119 community-dwelling Cardiovascular Health Study participants ≥65 years with incident HF. Data on HF and mortality were collected through annual examinations or contact during the 10-year follow-up period. Slower gait speed (<0.8 m/s vs ≥0.8 m/s) and IADL impairment (≥1 vs 0 areas of dependence) were determined from baseline and follow-up assessments. A total of 740 (66%) of the 1,119 participants died during the follow-up period. Multivariate Cox proportional hazards models showed that impairments in either gait speed (hazard ratio 1.37, 95% confidence interval 1.10 to 1.70; p = 0.004) or IADL (hazard ratio 1.56, 95% confidence interval 1.29-1.89; p <0.001), measured within 1 year before the diagnosis of incident HF, were independently associated with mortality, adjusting for sociodemographic and clinical characteristics. The combined presence of slower gait speed and IADL impairment was associated with a greater risk of mortality and suggested an additive relation between gait speed and IADL. In conclusion, gait speed and IADL are important risk factors for mortality in adults ≥65 years with HF, but the combined impairments of both gait speed and IADL can have an especially important impact on mortality.
authors: Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Comprehensive Center for Healthy Aging, Birmingham, Alabama. Electronic address: alexanderlo@uabmc.edu.
authors: Alexander X
authors: AX
authors: Lo
authors: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Medicine, Center for Outcomes and Effectiveness Research Education, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors: John P
authors: JP
authors: Donnelly
authors: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Gerald
authors: G
authors: McGwin
authors: Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Vera
authors: V
authors: Bittner
authors: Veterans Affairs Medical Center, Washington, District of Columbia.
authors: Ali
authors: A
authors: Ahmed
authors: Comprehensive Center for Healthy Aging, Birmingham, Alabama; Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama; Birmingham VA Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Birmingham, Alabama.
authors: Cynthia J
authors: CJ
authors: Brown
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D005684:Gait; D015577:Geriatric Assessment; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014481:United States; D016138:Walking
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