Decline in Functional Performance Predicts Later Increased Mobility Loss and Mortality in Peripheral Arterial Disease

Q: What are the key findings of this study?

Greater two-year decline in walking distance increased the risk of subsequent mobility loss and all-cause mortality in PAD.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Peripheral arterial disease (PAD) (n=440). Intervention: Two-year decline in six-minute walk performance (greatest decline tertile) vs. Smallest two-year decline in six-minute walk performance (third tertile). Primary outcome: Subsequent mobility loss (becoming unable to walk 1/4 mile or climb up and down one flight of stairs without assistance) (HR 3.50, 95% CI 1.56–7.85, p=0.002).

Q: What does this research mean for the field?

A two-year decline in functional performance measures independently predicts an increased risk of subsequent mobility loss, all-cause mortality, and cardiovascular mortality in patients with peripheral arterial disease. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mary Mcdermott; Kiang Liu; Luigi Ferrucci; Lü Tian; Jack M. Guralnik; Yihua Liao; Michael H. Criqui

doi:10.1016/j.jacc.2010.09.053

February 1, 2011Journal of the American College of CardiologyOpen Access

Decline in Functional Performance Predicts Later Increased Mobility Loss and Mortality in Peripheral Arterial Disease

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Key result

Greater 2-year walking distance decline in PAD is linked to ~3.5-fold higher risk of mobility loss.

HR 3.50
95% CI 1.56–7.85
P=0.002
n=440

Why the study?

Associations of decline in functional performance with clinically important outcomes such as mobility loss and mortality in patients with peripheral arterial disease were unknown.

Does a greater two-year decline in office-based functional performance measures predict increased subsequent mobility loss and mortality in patients with peripheral arterial disease?

Key Points

To determine whether greater two-year decline in office-based functional performance measures predicts subsequent mobility loss and mortality in patients with peripheral arterial disease.
Evaluated 440 men and women with peripheral arterial disease who completed the six-minute walk test and walking velocity measures at baseline and annually for two years.
Categorized participants into tertiles based on two-year functional decline and followed them annually for mortality and mobility loss over a median post-assessment follow-up of 44.5 months.
Used Cox proportional hazards models adjusted for age, sex, race, ankle brachial index, comorbidities, and other potential confounders.
Among 319 participants without baseline mobility disability, 60 (18.8%) developed mobility loss, with the greatest six-minute walk decline tertile having the highest subsequent mobility loss (HR=3.50, 95% CI=1.56–7.85, p=0.002).
Greater declines in fastest-paced four-meter walking velocity were also associated with higher mobility loss (P trend=0.018), all-cause mortality (P trend=0.01), and cardiovascular disease mortality (P trend=0.004).

Study Design

Type

Cohort (n=440)

Multicenter

Yes

Structured PICO

Does a greater two-year decline in office-based functional performance measures predict increased subsequent mobility loss and mortality in patients with peripheral arterial disease?

P

Population

440 older adults (age >=55, 43.2% female) with peripheral arterial disease (ABI <0.90) from three Chicago-area vascular laboratories, followed for a median of 44.5 months after a 2-year functional change assessment.

E

Exposure

Greater two-year decline (first tertile vs. third tertile) in office-based functional performance measures assessed annually over two years: six-minute walk test, four-meter walking velocity at usual and fastest pace, and the Short Physical Performance Battery (SPPB)

C

Comparator

Smallest two-year decline (third tertile) in office-based functional performance measures over the two-year period

O

Outcome

Mobility loss (defined as becoming unable to walk 1/4 mile or walk up and down one flight of stairs without assistance) and all-cause and cardiovascular disease mortality (ICD-10 codes I01.0-I99.9) at a median follow-up of 44.5 months (IQR 26.0 to 73.0 months) after the two-year functional change assessmenthard clinical

Main Result

Hazard Ratio: 3.5 (95% CI 1.56–7.85)

p-value: p=0.002

Limitations

Observational study design precludes causal inference
Findings may not be generalizable to PAD patients without two years of functional performance measures
Findings are not generalizable to PAD patients who undergo lower extremity revascularization during the two-year measurement of functional change
Use of death certificates to ascertain cardiovascular death may be associated with misclassification compared to adjudicated cause of death
Observational study design prevents establishing causal associations
Findings are not generalizable to PAD patients who undergo lower extremity revascularization during the two-year measurement period
Use of death certificates to ascertain cardiovascular death may be associated with misclassification

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Answers are grounded in this paper and cite their sources.

Implication

Serial annual office-based functional performance testing over two years identifies PAD patients at significantly elevated risk for subsequent mobility loss, all-cause mortality, and cardiovascular mortality independently of baseline functional status and ABI.

Abstract

BACKGROUND: Associations of decline in functional performance with clinically-important outcomes in patients with peripheral arterial disease (PAD) are unknown. OBJECTIVES: We hypothesized that greater two-year decline in office-based functional performance measures would be associated with greater mobility loss and mortality in people with PAD. METHODS: 440 men and women with PAD completed the six-minute walk test and measures of walking velocity at baseline and annually for two years. Participants were categorized into tertiles according to their functional decline between baseline and two-year follow-up and were followed annually after the functional change assessment. Cox proportional hazard models were used to assess relations between the two-year change in functional performance with later mortality and mobility loss, adjusting for age, sex, race, the ankle brachial index, comorbidities, and other confounders. RESULTS: One hundred two participants (23.2%) died during a median follow-up of 44.5 months after functional change was assessed. Of 319 participants without baseline mobility disability, 60 (18.8%) developed mobility loss after functional change was assessed. Participants in the tertile with greatest six-minute walk decline had the highest subsequent mobility loss (Hazard Ratio (HR)=3.50, 95% Confidence Interval (CI)=1.56–7.85, p=0.002), all-cause mortality (HR=2.16, 95% CI=1.28–3.64, p=0.004), and cardiovascular disease (CVD) mortality (HR=2.45, 95% CI=1.08–5.54, p=0.031), compared to those with the smallest six-minute walk decline. Greater declines in fastest paced four-meter walking velocity were associated with higher mobility loss (P trend=0.018), all-cause mortality (P trend=0.01) and CVD mortality (P trend=0.004). CONCLUSION: PAD participants with declining functional performance are at increased risk for later mobility loss and mortality.

Discussion

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Cite This Study

Mcdermott et al. (2011) conducted a cohort in Peripheral arterial disease (PAD) (n=440). Two-year decline in six-minute walk performance (greatest decline tertile) vs. Smallest two-year decline in six-minute walk performance (third tertile) was evaluated on Subsequent mobility loss (becoming unable to walk 1/4 mile or climb up and down one flight of stairs without assistance) (HR 3.50, 95% CI 1.56–7.85, p=0.002). Greater two-year decline in walking distance increased the risk of subsequent mobility loss and all-cause mortality in PAD.

synapsesocial.com/papers/6a87c39c30025d752084af5a https://doi.org/10.1016/j.jacc.2010.09.053

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Decline in Functional Performance Predicts Later Increased Mobility Loss and Mortality in Peripheral Arterial Disease

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Decline in Functional Performance Predicts Later Increased Mobility Loss and Mortality in Peripheral Arterial Disease

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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