title: 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: OBJECTIVE
  To determine the prognostic value of slow gait in predicting outcomes 1 year after acute myocardial infarction (AMI).
  
  
  METHODS
  Observational cohort with longitudinal follow-up.
  
  
  METHODS
  Twenty-four U.S. hospitals participating in the Translational Research Investigating Underlying disparities in recovery from acute Myocardial infarction: Patients' Health status Registry.
  
  
  METHODS
  Older adults (≥65) with in-home gait assessment 1 month after AMI (N = 338).
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Leon H. Charney Division of Cardiology, Department of Medicine, School of Medicine, New York University, New York, New York.
authors.forename: John A
authors.initials: JA
authors.lastname: Dodson
authors.affiliation: Saint Luke's Mid America Heart Institute, University of Missouri at Kansas City, Kansas City, Missouri.
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: Arnold
authors.affiliation: Saint Luke's Mid America Heart Institute, University of Missouri at Kansas City, Kansas City, Missouri.
authors.forename: Kensey L
authors.initials: KL
authors.lastname: Gosch
authors.affiliation: Section of Geriatrics, Yale University New Haven, New Haven, Connecticut.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Gill
authors.affiliation: Saint Luke's Mid America Heart Institute, University of Missouri at Kansas City, Kansas City, Missouri.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Section of Cardiovascular Medicine, Yale University New Haven, New Haven, Connecticut.|Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, School of Medicine, Yale University New Haven, New Haven, Connecticut.|Department of Health Policy and Management, School of Public Health, Yale University New Haven, New Haven, Connecticut.|Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: Division of Cardiology, Department of Medicine, School of Medicine, Washington University, St. Louis, Missouri.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rich
authors.affiliation: Section of General Internal Medicine, Yale University New Haven, Connecticut.
authors.forename: Sarwat I
authors.initials: SI
authors.lastname: Chaudhry
authors.affiliation: Division of Geriatric Cardiology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Forman
authors.affiliation: Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: Division of Cardiology, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina.
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005684:Gait; D054624:Health Status Disparities; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000503:physiopathology*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012042:Registries; D012307:Risk Factors; D057170:Translational Research, Biomedical; D014481:United States
keywords: coronary artery disease; frailty; older adults; outcomes