title: Gait Speed Predicts 30-Day Mortality After Transcatheter Aortic Valve Replacement: Results From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.
abstract: BACKGROUND
  Surgical risk scores do not include frailty assessments (eg, gait speed), which are of particular importance for patients with severe aortic stenosis considering transcatheter aortic valve replacement.
  
  
  RESULTS
  We assessed the association of 5-m gait speed with outcomes in a cohort of 8039 patients who underwent transcatheter aortic valve replacement (November 2011-June 2014) and were included in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. We evaluated the association between continuous and categorical gait speed and 30-day all-cause mortality before and after adjustment for Society of Thoracic Surgeons-predicted risk of mortality score and key variables. Secondary outcomes included in-hospital mortality, bleeding, acute kidney injury, and stroke. The overall median gait speed was 0.63 m/s (25th-75th percentile, 0.47-0.79 m/s), with the slowest walkers (<0.5 m/s) constituting 28%, slow walkers (0.5-0.83 m/s) making up 48%, and normal walkers (>0.83 m/s) constituting 24% of the population. Thirty-day all-cause mortality rates were 8.4%, 6.6%, and 5.4% for the slowest, slow, and normal walkers, respectively (P<0.001). Each 0.2-m/s decrease in gait speed corresponded to an 11% increase in 30-day mortality (adjusted odds ratio, 1.11; 95% confidence interval, 1.01-1.22). The slowest walkers had 35% higher 30-day mortality than normal walkers (adjusted odds ratio, 1.35; 95% confidence interval, 1.01-1.80), significantly longer hospital stays, and a lower probability of being discharged to home.
  
  
  CONCLUSIONS
  Gait speed is independently associated with 30-day mortality after transcatheter aortic valve replacement. Identification of frail patients with the slowest gait speeds facilitates preprocedural evaluation and anticipation of a higher level of postprocedural care.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01737528.
authors.affiliation: From Duke Clinical Research Institute, Durham, NC (J. Alfredsson, A.S., E.D.P., K.P.A.); Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden (J. Alfredsson); Duke University School of Medicine, Durham, NC (J.M.B., R.M., E.D.P., S.V., K.P.A.); Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (J. Afilalo); University of Colorado School of Medicine, Aurora (J.S.R.); Massachusetts General Hospital, Boston (D.S.); and Baylor Scott & White Health, Plano, TX (M.J.M.).
authors.forename: Joakim
authors.initials: J
authors.lastname: Alfredsson
authors.affiliation: From Duke Clinical Research Institute, Durham, NC (J. Alfredsson, A.S., E.D.P., K.P.A.); Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden (J. Alfredsson); Duke University School of Medicine, Durham, NC (J.M.B., R.M., E.D.P., S.V., K.P.A.); Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (J. Afilalo); University of Colorado School of Medicine, Aurora (J.S.R.); Massachusetts General Hospital, Boston (D.S.); and Baylor Scott & White Health, Plano, TX (M.J.M.).
authors.forename: Amanda
authors.initials: A
authors.lastname: Stebbins
authors.affiliation: From Duke Clinical Research Institute, Durham, NC (J. Alfredsson, A.S., E.D.P., K.P.A.); Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden (J. Alfredsson); Duke University School of Medicine, Durham, NC (J.M.B., R.M., E.D.P., S.V., K.P.A.); Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (J. Afilalo); University of Colorado School of Medicine, Aurora (J.S.R.); Massachusetts General Hospital, Boston (D.S.); and Baylor Scott & White Health, Plano, TX (M.J.M.).
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Brennan
authors.affiliation: From Duke Clinical Research Institute, Durham, NC (J. Alfredsson, A.S., E.D.P., K.P.A.); Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden (J. Alfredsson); Duke University School of Medicine, Durham, NC (J.M.B., R.M., E.D.P., S.V., K.P.A.); Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (J. Afilalo); University of Colorado School of Medicine, Aurora (J.S.R.); Massachusetts General Hospital, Boston (D.S.); and Baylor Scott & White Health, Plano, TX (M.J.M.).
authors.forename: Roland
authors.initials: R
authors.lastname: Matsouaka
authors.affiliation: From Duke Clinical Research Institute, Durham, NC (J. Alfredsson, A.S., E.D.P., K.P.A.); Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden (J. Alfredsson); Duke University School of Medicine, Durham, NC (J.M.B., R.M., E.D.P., S.V., K.P.A.); Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (J. Afilalo); University of Colorado School of Medicine, Aurora (J.S.R.); Massachusetts General Hospital, Boston (D.S.); and Baylor Scott & White Health, Plano, TX (M.J.M.).
authors.forename: Jonathan
authors.initials: J
authors.lastname: Afilalo
authors.affiliation: From Duke Clinical Research Institute, Durham, NC (J. Alfredsson, A.S., E.D.P., K.P.A.); Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden (J. Alfredsson); Duke University School of Medicine, Durham, NC (J.M.B., R.M., E.D.P., S.V., K.P.A.); Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (J. Afilalo); University of Colorado School of Medicine, Aurora (J.S.R.); Massachusetts General Hospital, Boston (D.S.); and Baylor Scott & White Health, Plano, TX (M.J.M.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: From Duke Clinical Research Institute, Durham, NC (J. Alfredsson, A.S., E.D.P., K.P.A.); Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden (J. Alfredsson); Duke University School of Medicine, Durham, NC (J.M.B., R.M., E.D.P., S.V., K.P.A.); Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (J. Afilalo); University of Colorado School of Medicine, Aurora (J.S.R.); Massachusetts General Hospital, Boston (D.S.); and Baylor Scott & White Health, Plano, TX (M.J.M.).
authors.forename: Sreekanth
authors.initials: S
authors.lastname: Vemulapalli
authors.affiliation: From Duke Clinical Research Institute, Durham, NC (J. Alfredsson, A.S., E.D.P., K.P.A.); Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden (J. Alfredsson); Duke University School of Medicine, Durham, NC (J.M.B., R.M., E.D.P., S.V., K.P.A.); Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (J. Afilalo); University of Colorado School of Medicine, Aurora (J.S.R.); Massachusetts General Hospital, Boston (D.S.); and Baylor Scott & White Health, Plano, TX (M.J.M.).
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.affiliation: From Duke Clinical Research Institute, Durham, NC (J. Alfredsson, A.S., E.D.P., K.P.A.); Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden (J. Alfredsson); Duke University School of Medicine, Durham, NC (J.M.B., R.M., E.D.P., S.V., K.P.A.); Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (J. Afilalo); University of Colorado School of Medicine, Aurora (J.S.R.); Massachusetts General Hospital, Boston (D.S.); and Baylor Scott & White Health, Plano, TX (M.J.M.).
authors.forename: David
authors.initials: D
authors.lastname: Shahian
authors.affiliation: From Duke Clinical Research Institute, Durham, NC (J. Alfredsson, A.S., E.D.P., K.P.A.); Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden (J. Alfredsson); Duke University School of Medicine, Durham, NC (J.M.B., R.M., E.D.P., S.V., K.P.A.); Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (J. Afilalo); University of Colorado School of Medicine, Aurora (J.S.R.); Massachusetts General Hospital, Boston (D.S.); and Baylor Scott & White Health, Plano, TX (M.J.M.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.affiliation: From Duke Clinical Research Institute, Durham, NC (J. Alfredsson, A.S., E.D.P., K.P.A.); Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden (J. Alfredsson); Duke University School of Medicine, Durham, NC (J.M.B., R.M., E.D.P., S.V., K.P.A.); Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (J. Afilalo); University of Colorado School of Medicine, Aurora (J.S.R.); Massachusetts General Hospital, Boston (D.S.); and Baylor Scott & White Health, Plano, TX (M.J.M.). karen.alexander@duke.edu.
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D005684:Gait; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D020521:Stroke / Q000453:epidemiology; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality*
keywords: aged; aortic valve stenosis; heart valve diseases; transcatheter aortic valve replacement