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J Am Heart Assoc. 2018 Feb 24;7(5). pii: e008296. doi: 10.1161/JAHA.117.008296.

Slow Gait Speed and Cardiac Rehabilitation Participation in Older Adults After Acute Myocardial Infarction.

Author information

1
Division of Cardiology, University of Colorado, Aurora, CO kelsey.flint@ucdenver.edu.
2
Colorado Cardiovascular Outcomes Research, Aurora, CO.
3
Saint Luke's Mid America Heart Institute Saint Luke's Health System, Kansas City, MO.
4
University of Missouri-Kansas City, Kansas City, MO.
5
Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY.
6
Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine, New York, NY.
7
Cardiovascular Division, Washington University in St Louis, MO.
8
Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.

Abstract

BACKGROUND:

Lack of participation in cardiac rehabilitation (CR) and slow gait speed have both been associated with poor long-term outcomes in older adults after acute myocardial infarction (AMI). Whether the effect of CR participation on outcomes after AMI differs by gait speed is unknown.

METHODS AND RESULTS:

We examined the association between gait speed and CR participation at 1 month after discharge after AMI, and death and disability at 1 year, in 329 patients aged ≥65 years enrolled in the TRIUMPH (Translational Research Investigating Underlying Disparities in Recovery From Acute Myocardial Infarction: Patients' Health Status) registry. Among these patients, 177 (53.7%) had slow gait speed (<0.8 m/s) and 109 (33.1%) participated in CR. Patients with slow gait speed were less likely to participate in CR compared with patients with normal gait speed (27.1% versus 40.1%; P=0.012). In unadjusted analysis, CR participants with normal gait speed had the lowest rate of death or disability at 1 year (9.3%), compared with those with slow gait speed and no CR participation (43.2%). After adjustment for cardiovascular risk factors and cognitive impairment, both slow gait speed (odds ratio, 2.30; 95% confidence interval, 1.30-4.06) and non-CR participation (odds ratio, 2.34; 95 confidence interval, 1.22-4.48) were independently associated with death or disability at 1 year. The effect of CR on the primary outcome did not differ by gait speed (P=0.70).

CONCLUSIONS:

CR participation is associated with reduced risk for death or disability after AMI. The beneficial effect of CR participation does not differ by gait speed, suggesting that slow gait speed alone should not preclude referral to CR for older adults after AMI.

KEYWORDS:

acute myocardial infarction; cardiac rehabilitation; frailty; function; gait speed

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