Novel Gait Speed Cut‐Off Values Associated With Prognosis in Older Patients With Heart Failure

Background

Gait speed is an independent prognostic factor in patients with heart failure (HF) and is recognized as a therapeutic target. Although a single cutoff of 0.98 m/s has been proposed based on post‐discharge prognosis, the continuous relationship between gait speed and outcomes suggests the possible presence of multiple cutoffs. Identifying these thresholds may help establish stepwise, attainable goals for a broad range of older HF patients. This study aimed to determine whether additional prognostic gait speed cutoffs exist at discharge in older HF patients.

Methods

We conducted a secondary analysis of the J‐Proof HF, comprising 7326 hospitalized patients aged ≥ 65 years with confirmed HF. The cohort was randomly divided into a derivation (60%) and a validation (40%) cohort. The primary outcome was a composite of all‐cause death or HF readmission within 1 year. Gait speed cutoffs were identified in the derivation cohort using survival classification and regression tree (CART) analysis and validated in the validation cohort.

Results

Three prognostic cutoffs were identified (< 0.39, < 0.69, and < 1.00 m/s), defining four gait speed categories. Patients with slower gait speed were older, had more comorbidities, and poorer physical function. Gait speed category remained independently associated with outcomes (HR 1.21, 95% CI 1.13–1.30).

Conclusions

This study established new prognostic gait speed cutoffs in older HF patients, which may help set individualized physiotherapy goals based on patient mobility.

Trial Registration: ClinicalTrials.gov identifier: UMIN000047893