Abstract 13870: Association of Gait Speed and Cardiac Rehabilitation With Death and Disability Following Acute Myocardial Infarction

Abstract

Background: Slow gait speed is associated with worse outcomes in older patients after acute myocardial infarction (AMI). Cardiac rehabilitation (CR) may improve outcomes in these patients, however participation in CR may be challenging in older patients with limited mobility. We assessed for an association between gait speed and CR participation, and examined whether CR modifies the association between slow gait speed (<0.8m/sec) and 1-year outcomes. Methods: Among patients ≥ 65 years old enrolled in TRIUMPH (24-site US AMI registry) assessed with a 5-meter walk test at 1-month after AMI, we measured CR participation in patients with slow and normal gait speed. CR participation was self-reported 1 month after AMI. The association between slow gait speed and CR participation with death or disability (i.e., ADL loss) was assessed with multivariable logistic regression. We also measured the interaction between slow gait speed and CR participation with the outcomes. Results: Among 329 older patients, 177 (54%) had slow gait speed 1 month after AMI. 48 (27%) patients with slow gait speed participated in CR, whereas 62 (40%) patients with normal gait speed participated in CR (p=0.012). Patients with slow gait speed who did not participate in CR were most likely to experience death or disability at 1 year following AMI (43%), while similar outcomes were noted for slow gait speed/CR group (24%) and normal gait speed/no CR group (24%), with best outcomes in the normal gait speed/CR group (9%). In a multivariable model (Figure), lack of CR and slow gait speed were independently associated with death or loss of ADL at 1 year after adjustment for GRACE score and cognitive impairment. There was no interaction between gait speed, CR participation and 1-year mortality or disability (p interaction=0.67). Conclusions: Less CR participation is notable among older patients with slow gait speed; however, CR participation is associated with improved outcomes after AMI, regardless of gait speed.