MedicalResearch.com Interview with:
Giovanni Pulignano, MD, FANMCO
Dirigente Cardiologo/ Senior Cardiologist
I UO Cardiologia /UTIC/Gruppo Operativo Interdisciplinare Scompenso Cardiaco
Heart Failure Unit/ Cardiology Unit/CCU
Azienda Ospedaliera San Camillo-Forlanini, Roma
S.Camillo-Forlanini Hospital, Rome, Italy
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Pulignano: As the population ages, heart failure (HF)is becoming increasingly common, with a high burden of disability, morbidity, and mortality. A significant proportion of patients with heart failure are frail and have impairments in gait speed.
The prognosis of older patients depends not only on cardiac diseases or comorbidities but also on geriatric conditions, such as disability, cognitive impairment, and frailty, as a consequence of their biological heterogeneity. We chose gait speed as a marker of frailty for its high feasibility – requiring just a corridor and a digital stopwatch – and added it to the 3C-HF score, a well validated heart failure model with a high predictive performance for including comorbidities, in order to improves risk stratification in older patients.
In our study nearly 35% of patients showed severely reduced gait speeds that were significantly associated with an increased 1-year event rate, independent of conventional heart failure prognostic factors.
Besides confirming the association with mortality and hospitalizations, when added to the 3C-HF score, indeed, gait speed improved its prognostic accuracy, allowing us to reclassify patients in more appropriate risk categories.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Pulignano: This is the first study to test the incremental value of gait speed in predicting prognosis in older patients with heart failure in combination with a validated clinical risk score, the 3C-HF. Frailty assessment using gait speed is simple and inexpensive, and its measurement could be easily incorporated in the routine clinical evaluation of older patients with HF. In times of financial restraints affecting national health services, an accurate assessment of the individual risk for adverse outcomes focused on a tailored therapy and informed shared decision making is warranted. Early detection of frailty in patients with heart failure may lead to interventions to prevent or reverse the development of frailty itself, such as regular physical exercise and balanced nutrition, to improve not only function and quality of life but also survival, if possible
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Pulignano: According to our results, we can speculate that frail patients with heart failure may be enrolled in long-term management programs that incorporate geriatric assessment, HF clinics, and exercise, aimed at the prevention of functional decline and clinical events. However, it has yet to be determined whether targeting frailty with interventions may actually improve patient-centered and clinical outcomes. Thus, the optimal design of these interventions and their impact on outcomes is still an area of investigation; further studies should address this issue.
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Pulignano G, Del Sindaco D, Di Lenarda A, et al. Incremental Value of Gait Speed in Predicting Prognosis of Older Adults With Heart Failure: Insights From the IMAGE-HF Study.JCHF. 2016;():. doi:10.1016/j.jchf.2015.12.017.
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Dr. Giovanni Pulignano (2016). Impaired Gait Speed Predicts Adverse Events in Heart Failure MedicalResearch.com