Decline in functional performance predicts later increased mobility loss and mortality in peripheral arterial disease

Mary M. McDermott, Kiang Liu, Luigi Ferrucci, Lu Tian, Jack M. Guralnik, Yihua Liao, Michael H. Criqui

Research output: Contribution to journalArticle

Abstract

Objectives: We hypothesized that a greater 2-year decline in office-based functional performance measures would be associated with greater mobility loss and mortality in people with peripheral arterial disease (PAD). Background: Associations of decline in functional performance with clinically important outcomes in patients with PAD are unknown. Methods: A total of 440 men and women with PAD completed the 6-min walk test and measures of walking velocity at baseline and annually for 2 years. Participants were categorized into tertiles according to their functional decline between baseline and 2-year follow-up and were followed annually after the functional change assessment. Cox proportional hazard models were used to assess relations between the 2-year change in functional performance with later mortality and mobility loss, with adjustments for age, sex, race, ankle brachial index, comorbidities, and other confounders. Results: A total of 102 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 the greatest 6-min walk decline had the highest subsequent mobility loss (hazard ratio [HR]: 3.50; 95% confidence interval [CI]: 1.56 to 7.85; p = 0.002), all-cause mortality (HR: 2.16; 95% CI: 1.28 to 3.64; p = 0.004), and cardiovascular disease mortality (HR: 2.45; 95% CI: 1.08 to 5.54; p = 0.031), compared with those with the smallest 6-min walk decline. Greater declines in fastest-paced 4-m walking velocity were associated with higher mobility loss (p trend = 0.018), all-cause mortality (p trend = 0.01), and cardiovascular mortality (p trend = 0.004). Conclusions: Participants with PAD with declining functional performance are at increased risk for later mobility loss and mortality.

Original languageEnglish (US)
Pages (from-to)962-970
Number of pages9
JournalJournal of the American College of Cardiology
Volume57
Issue number8
DOIs
StatePublished - Feb 22 2011
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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