Lo Alexander X, Donnelly John P, McGwin Gerald, Bittner Vera, Ahmed Ali, Brown Cynthia J
Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Comprehensive Center for Healthy Aging, Birmingham, Alabama.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Medicine, Center for Outcomes and Effectiveness Research Education, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Am J Cardiol. 2015 Mar 15;115(6):797-801. doi: 10.1016/j.amjcard.2014.12.044. Epub 2015 Jan 6.
Mobility and function are important predictors of survival. However, their combined impact on mortality in adults ≥65 years with heart failure (HF) is not well understood. This study examined the role of gait speed and instrumental activities of daily living (IADL) in all-cause mortality in a cohort of 1,119 community-dwelling Cardiovascular Health Study participants ≥65 years with incident HF. Data on HF and mortality were collected through annual examinations or contact during the 10-year follow-up period. Slower gait speed (<0.8 m/s vs ≥0.8 m/s) and IADL impairment (≥1 vs 0 areas of dependence) were determined from baseline and follow-up assessments. A total of 740 (66%) of the 1,119 participants died during the follow-up period. Multivariate Cox proportional hazards models showed that impairments in either gait speed (hazard ratio 1.37, 95% confidence interval 1.10 to 1.70; p = 0.004) or IADL (hazard ratio 1.56, 95% confidence interval 1.29-1.89; p <0.001), measured within 1 year before the diagnosis of incident HF, were independently associated with mortality, adjusting for sociodemographic and clinical characteristics. The combined presence of slower gait speed and IADL impairment was associated with a greater risk of mortality and suggested an additive relation between gait speed and IADL. In conclusion, gait speed and IADL are important risk factors for mortality in adults ≥65 years with HF, but the combined impairments of both gait speed and IADL can have an especially important impact on mortality.
身体活动能力和功能是生存的重要预测指标。然而，它们对≥65岁心力衰竭（HF）成人死亡率的综合影响尚不清楚。本研究在1119名≥65岁社区居住的心血管健康研究参与者队列中，调查了步态速度和日常生活工具性活动（IADL）在全因死亡率中的作用，这些参与者患有新发HF。在10年随访期内，通过年度检查或联系收集HF和死亡率数据。根据基线和随访评估确定步态速度较慢（<0.8米/秒与≥0.8米/秒）和IADL受损（≥1个依赖区域与0个依赖区域）。1119名参与者中有740名（66%）在随访期间死亡。多变量Cox比例风险模型显示，在诊断新发HF前1年内测量的步态速度（风险比1.37，95%置信区间1.10至1.70；p = 0.004）或IADL（风险比1.56，95%置信区间1.29 - 1.89；p <0.001）受损，在调整社会人口统计学和临床特征后，均与死亡率独立相关。步态速度较慢和IADL受损同时存在与更高的死亡风险相关，提示步态速度和IADL之间存在相加关系。总之，步态速度和IADL是≥65岁HF成人死亡率的重要危险因素，但步态速度和IADL的联合受损对死亡率可能有特别重要的影响。
