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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.

Publication ,  Journal Article
Alfredsson, J; Stebbins, A; Brennan, JM; Matsouaka, R; Afilalo, J; Peterson, ED; Vemulapalli, S; Rumsfeld, JS; Shahian, D; Mack, MJ; Alexander, KP
Published in: Circulation
April 5, 2016

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. METHODS AND 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. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01737528.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

April 5, 2016

Volume

133

Issue

14

Start / End Page

1351 / 1359

Location

United States

Related Subject Headings

  • Transcatheter Aortic Valve Replacement
  • Stroke
  • Registries
  • Prospective Studies
  • Prognosis
  • Postoperative Hemorrhage
  • Postoperative Complications
  • Mobility Limitation
  • Male
  • Humans
 

Citation

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Alfredsson, J., Stebbins, A., Brennan, J. M., Matsouaka, R., Afilalo, J., Peterson, E. D., … Alexander, K. P. (2016). 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. Circulation, 133(14), 1351–1359. https://doi.org/10.1161/CIRCULATIONAHA.115.020279
Alfredsson, Joakim, Amanda Stebbins, J Matthew Brennan, Roland Matsouaka, Jonathan Afilalo, Eric D. Peterson, Sreekanth Vemulapalli, et al. “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.Circulation 133, no. 14 (April 5, 2016): 1351–59. https://doi.org/10.1161/CIRCULATIONAHA.115.020279.
Alfredsson, Joakim, et al. “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.Circulation, vol. 133, no. 14, Apr. 2016, pp. 1351–59. Pubmed, doi:10.1161/CIRCULATIONAHA.115.020279.
Alfredsson J, Stebbins A, Brennan JM, Matsouaka R, Afilalo J, Peterson ED, Vemulapalli S, Rumsfeld JS, Shahian D, Mack MJ, Alexander KP. 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. Circulation. 2016 Apr 5;133(14):1351–1359.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

April 5, 2016

Volume

133

Issue

14

Start / End Page

1351 / 1359

Location

United States

Related Subject Headings

  • Transcatheter Aortic Valve Replacement
  • Stroke
  • Registries
  • Prospective Studies
  • Prognosis
  • Postoperative Hemorrhage
  • Postoperative Complications
  • Mobility Limitation
  • Male
  • Humans