scholarly journals Smartphone-Based Prediction Model for Postoperative Cardiac Surgery Outcomes Using Preoperative Gait and Posture Measures

Sensors ◽  
2021 ◽  
Vol 21 (5) ◽  
pp. 1704
Author(s):  
Rahul Soangra ◽  
Thurmon Lockhart
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Cardiac Surgery ◽  
Regression Model ◽  
Mobile Phone ◽  
Gait Speed ◽  
Adverse Outcomes ◽  
Postoperative Outcomes ◽  
Mortality And Morbidity ◽  
Prediction Of Mortality

Gait speed assessment increases the predictive value of mortality and morbidity following older adults’ cardiac surgery. The purpose of this study was to improve clinical assessment and prediction of mortality and morbidity among older patients undergoing cardiac surgery through the identification of the relationships between preoperative gait and postural stability characteristics utilizing a noninvasive-wearable mobile phone device and postoperative cardiac surgical outcomes. This research was a prospective study of ambulatory patients aged over 70 years undergoing non-emergent cardiac surgery. Sixteen older adults with cardiovascular disease (Age 76.1 ± 3.6 years) scheduled for cardiac surgery within the next 24 h were recruited for this study. As per the Society of Thoracic Surgeons (STS) recommendation guidelines, eight of the cardiovascular disease (CVD) patients were classified as frail (prone to adverse outcomes with gait speed ≤ 0.833 m/s) and the remaining eight patients as non-frail (gait speed > 0.833 m/s). Treating physicians and patients were blinded to gait and posture assessment results not to influence the decision to proceed with surgery or postoperative management. Follow-ups regarding patient outcomes were continued until patients were discharged or transferred from the hospital, at which time data regarding outcomes were extracted from the records. In the preoperative setting, patients performed the 5-m walk and stand still for 30 s in the clinic while wearing a mobile phone with a customized app “Lockhart Monitor” available at iOS App Store. Systematic evaluations of different gait and posture measures identified a subset of smartphone measures most sensitive to differences in two groups (frail versus non-frail) with adverse postoperative outcomes (morbidity/mortality). A regression model based on these smartphone measures tested positive on five CVD patients. Thus, clinical settings can readily utilize mobile technology, and the proposed regression model can predict adverse postoperative outcomes such as morbidity or mortality events.

scholarly journals How wearable sensors have been utilised to evaluate frailty in older adults: a systematic review

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Grainne Vavasour ◽  
Oonagh M. Giggins ◽  
Julie Doyle ◽  
Daniel Kelly
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Gait Speed ◽  
Outcome Measurement ◽  
Wearable Sensors ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Ageing Population ◽  
Application Development ◽  
Community Dwelling Older Adults

Abstract Background Globally the population of older adults is increasing. It is estimated that by 2050 the number of adults over the age of 60 will represent over 21% of the world’s population. Frailty is a clinical condition associated with ageing resulting in an increase in adverse outcomes. It is considered the greatest challenge facing an ageing population affecting an estimated 16% of community-dwelling populations worldwide. Aim The aim of this systematic review is to explore how wearable sensors have been used to assess frailty in older adults. Method Electronic databases Medline, Science Direct, Scopus, and CINAHL were systematically searched March 2020 and November 2020. A search constraint of articles published in English, between January 2010 and November 2020 was applied. Papers included were primary observational studies involving; older adults aged > 60 years, used a wearable sensor to provide quantitative measurements of physical activity (PA) or mobility and a measure of frailty. Studies were excluded if they used non-wearable sensors for outcome measurement or outlined an algorithm or application development exclusively. The methodological quality of the selected studies was assessed using the Appraisal Tool for Cross-sectional Studies (AXIS). Results Twenty-nine studies examining the use of wearable sensors to assess and discriminate between stages of frailty in older adults were included. Thirteen different body-worn sensors were used in eight different body-locations. Participants were community-dwelling older adults. Studies were performed in home, laboratory or hospital settings. Postural transitions, number of steps, percentage of time in PA and intensity of PA together were the most frequently measured parameters followed closely by gait speed. All but one study demonstrated an association between PA and level of frailty. All reports of gait speed indicate correlation with frailty. Conclusions Wearable sensors have been successfully used to evaluate frailty in older adults. Further research is needed to identify a feasible, user-friendly device and body-location that can be used to identify signs of pre-frailty in community-dwelling older adults. This would facilitate early identification and targeted intervention to reduce the burden of frailty in an ageing population.

GAIT SPEED AND HANDGRIP STRENGTH AS PREDICTORS OF INCIDENT DISABILITY IN MEXICAN OLDER ADULTS

2014 ◽  
pp. 1-4
Author(s):  
T. LOPEZ-TEROS ◽  
L.M. GUTIERREZ-ROBLEDO ◽  
M.U. PEREZ-ZEPEDA
Keyword(s):  
Older Adults ◽  
Gait Speed ◽  
Daily Living ◽  
Handgrip Strength ◽  
Statistical Significance ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Performance Tests ◽  
One Year

Physical performance tests are associated with different adverse outcomes in older people. Theobjective of this study was to test the association between handgrip strength and gait speed with incidentdisability in community-dwelling, well-functioning, Mexican older adults (age ≥70 years). Incident disability wasdefined as the onset of any difficulty in basic or instrumental activities of daily living. Of a total of 133participants, 52.6% (n=70) experienced incident disability during one year of follow-up. Significant associationsof handgrip strength (odds ratio [OR] 0.96, 95% confidence interval [95%CI] 0.93-0.99) and gait speed (OR0.27, 95%CI 0.07-0.99) with incident disability were reported. The inclusion of covariates in the models reducedthe statistical significance of the associations without substantially modifying the magnitude of them. Handgripstrength and gait speed are independently associated with incident disability in Mexican older adults.

scholarly journals RISK FACTORS FOR LOW GAIT SPEED: A NESTED CASE-CONTROL SECONDARY ANALYSIS OF THE MEXICAN HEALTH AND AGING STUDY

2015 ◽  
pp. 1-5
Author(s):  
M.U. PÉREZ-ZEPEDA ◽  
J.G. GONZÁLEZ-CHAVERO ◽  
R. SALINAS-MARTINEZ ◽  
L.M. GUTIÉRREZ-ROBLEDO
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Physical Performance ◽  
Gait Speed ◽  
Representative Sample ◽  
Performance Test ◽  
Subsequent Development ◽  
Case Control ◽  
Adverse Outcomes ◽  
Aging Study

Background: Physical performance tests play a major role in the geriatric assessment. In particular, gait speed has shown to be useful for predicting adverse outcomes. However, risk factors for slow gait speed (slowness) are not clearly described. Objectives: To determine risk factors associated with slowness in Mexican older adults. Design: A two-step process was adopted for exploring the antecedent risk factors of slow gait speed. First, the cut-off values for gait speed were determined in a representative sample of Mexican older adults. Then, antecedent risk factors of slow gait speed (defined using the identified cut-points) were explored in a nested cohort case-control study. Setting, participants: One representative sample of a cross-sectional survey for the first step and the Mexican Health and Aging Study (a cohort characterized by a 10-year follow-up). Measurements: A 4-meter usual gait speed test was conducted. Lowest gender and height-stratified groups were considered as defining slow gait speed. Sociodemographic characteristics, comorbidities, psychological and health-care related variables were explored to find those associated with the subsequent development of slow gait speed. Unadjusted and adjusted logistic regression models were performed. Results: In the final model, age, diabetes, hypertension, and history of fractures were associated with the development of slow gait speed. Conclusions: Early identification of subjects at risk of developing slow gait speed may halt the path to disability due to the robust association of this physical performance test with functional decline.

Slow gait speed is associated with worse postoperative outcomes in cardiac surgery: A systematic review and meta‐analysis

2021 ◽  
Author(s):  
Jaewon Chang ◽  
Janice Nathalie ◽  
Minhtuan Nguyenhuy ◽  
Ruiwen Xu ◽  
Sohaib A Virk ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Gait Speed ◽  
Meta Analysis ◽  
Postoperative Outcomes

GAIT SPEED AND OPERATIVE MORTALITY IN OLDER ADULTS FOLLOWING CARDIAC SURGERY

2016 ◽  
Vol 32 (10) ◽  
pp. S244-S245
Author(s):  
J. Afilalo ◽  
S. Kim ◽  
S. O'Brien ◽  
J.M. Brennan ◽  
F.H. Edwards ◽  
...  
Keyword(s):  
Older Adults ◽  
Cardiac Surgery ◽  
Gait Speed ◽  
Operative Mortality

Frailty, sarcopenia, and falls in cardiovascular disease

ESC CardioMed ◽  
2018 ◽  
pp. 2950-2954
Author(s):  
Antonio Cherubini ◽  
Massimiliano Fedecostante
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Clinical Manifestations ◽  
Drug Effects ◽  
Adverse Outcomes ◽  
Assessment Tools ◽  
Management Approach ◽  
Older Individuals ◽  
Related Factors ◽  
Age Related

Frailty reflects a state of high vulnerability to stressors, even at low intensity, putting frail older adults at high risk of adverse outcomes. Sarcopenia (i.e. skeletal muscle decline) explains many of the clinical manifestations of the frailty syndrome and is the key component of physical frailty. Many frailty assessment tools are built around the concept of sarcopenia. Frailty is not only a consequence of the ageing process, but cardiovascular disease can contribute to its genesis, also sharing common pathogenetic pathways. Falls are very common in older individuals and are the best example of the interplay between age-related conditions and diseases. Falls, as well as frailty and sarcopenia, are most often multifactorial in nature. Cardiovascular disorders are among the risk factors that have been identified to cause falls in older adults; in particular, unexplained and recurrent falls. Orthostatic hypotension, carotid sinus syndrome, and adverse drug effects are the most important cardiovascular disease-related factors that have been found to be associated with falls in older people. Implementing the comprehensive geriatric assessment, a multidomain and multidisciplinary evaluation and management approach, represents the best strategy to properly manage older patients with cardiovascular disease.

scholarly journals Gait Speed and Operative Mortality in Older Adults Following Cardiac Surgery

2016 ◽  
Vol 1 (3) ◽  
pp. 314 ◽  
Author(s):  
Jonathan Afilalo ◽  
Sunghee Kim ◽  
Sean O’Brien ◽  
J. Matthew Brennan ◽  
Fred H. Edwards ◽  
...  
Keyword(s):  
Older Adults ◽  
Cardiac Surgery ◽  
Gait Speed ◽  
Operative Mortality

scholarly journals Role of Intraoperative and Postoperative Blood Glucose Concentrations in Predicting Outcomes after Cardiac Surgery

2010 ◽  
Vol 112 (4) ◽  
pp. 860-871 ◽  
Author(s):  
Andra E. Duncan ◽  
Alaa Abd-Elsayed ◽  
Ankit Maheshwari ◽  
Meng Xu ◽  
Edward Soltesz ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cleveland Clinic ◽  
Glycemic Variability ◽  
Adverse Outcomes ◽  
Mortality And Morbidity ◽  
Diabetic Status ◽  
Improved Outcomes ◽  
Increased Risk ◽  
Reduce Risk ◽  
Blood Glucose Concentrations

Background Severe hyperglycemia is associated with adverse outcomes after cardiac surgery. Whether intraoperative and postoperative glucose concentrations equally impact outcomes is unknown. The objective of this investigation was to compare the ability of perioperative glucose concentrations and glycemic variability to predict adverse outcomes. Risk associated with decreasing increments of glucose concentrations, hypoglycemia, and diabetic status was also examined. Methods This retrospective analysis of prospectively collected data included 4,302 patients who underwent cardiac surgery between October 3, 2005 and May 31, 2007 at the Cleveland Clinic. Time-weighted mean intraoperative (GlcOR) and postoperative (GlcICU) glucose concentrations were calculated. Patients were categorized as follows: Glc more than 200, 171-200, 141-170, and less than or equal to 140 mg/dl. Coefficient of variation was used to calculate glycemic variability. Logistic regression model with backward selection assessed the relationship between glucose concentrations, variability, and adverse outcomes while adjusting for potential confounders. Another model assessed the predictability of GlcOR and GlcICU on adverse outcomes. Results Both GlcOR and GlcICU predicted risk for mortality and morbidity. Increased postoperative glycemic variability was associated with increased risk for adverse outcomes. Severe hyperglycemia (GlcOR and GlcICU > 200 mg/dl) was associated with worse outcomes; however, decreasing increments of GlcOR did not consistently reduce risk. GlcOR less than or equal to 140 mg/dl was not associated with improved outcomes compared with severe hyperglycemia, despite infrequent hypoglycemia. Diabetic status did not influence the effects of hyperglycemia. Conclusion Perioperative glucose concentrations and glycemic variability are important in predicting outcomes after cardiac surgery. Incremental decreases of intraoperative glucose concentrations did not consistently reduce risk. Despite rare hypoglycemia, intraoperative glucose concentrations closest to normoglycemia were associated with worse outcomes.

scholarly journals Gait Speed Is Not Associated with Vasogenic Shock or Cardiogenic Shock following Cardiac Surgery, but Is Associated with Increased Hospital Length of Stay

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Kimmie Clark ◽  
Taylor Leathers ◽  
Duncan Rotich ◽  
Jianghua He ◽  
Katy Wirtz ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Gait Speed ◽  
Tertiary Care ◽  
Hospital Length ◽  
Permanent Pacemaker ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Academic Hospital ◽  
Total Hospital

Objective. Frailty has been associated with adverse outcomes following cardiac surgery. Gait speed has been validated as a marker of frailty. Slow gait speed has been found to be associated with mortality after cardiac surgery. However, it is unknown why slow gait speed predisposes to cardiac surgical mortality. Design. A retrospective analysis. Participants. Patients undergoing cardiac surgery who had a 5-meter walk test performed preoperatively (n=333 of 1735 total surgical patients) from January 2013 to March 2017. Setting. A tertiary care academic hospital. Measurements and main results. Gait speeds were stratified by tertiles: <0.83 m/s, 0.83–1 m/s, and >1 m/s. There was no difference in the incidence of cardiogenic or vasogenic shock when comparing the gait speed groups. Total hospital length of stay was significantly different among the gait speed groups (p=0.0050). Also, patients in the slowest gait speed tertile had a significant association with need for a postoperative permanent pacemaker (p=0.0298). Conclusion. There was no significant association between gait speed and the incidence of cardiogenic or vasogenic shock after cardiac surgery. Gait speed was associated with increased hospital length of stay and need for a permanent pacemaker after cardiac surgery.

Office-Based Physical Assessment in Patients Aged 75 Years and Older with Cardiovascular Disease

Gerontology ◽  
2019 ◽  
Vol 65 (2) ◽  
pp. 128-135 ◽  
Author(s):  
Ryota Matsuzawa ◽  
Kentaro Kamiya ◽  
Nobuaki Hamazaki ◽  
Kohei Nozaki ◽  
Shinya Tanaka ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Physical Performance ◽  
Mortality Risk ◽  
Gait Speed ◽  
Handgrip Strength ◽  
Walk Distance ◽  
Physical Assessment ◽  
All Cause Mortality ◽  
Usual Gait Speed

Background: The detection of impaired physical performance in older adults with cardiovascular disease is essential for clinical management and therapeutic decision-making. There is a requirement for an assessment tool that can be used conveniently, rapidly, and securely in clinical practice for screening decreased physical performance. Objective: The present study was performed to evaluate the association of office-based physical assessments with decreased physical performance and to compare the prognostic capability of these assessments in older adults with cardiovascular disease. Methods: A total of 1,040 patients aged 75 years and older with cardiovascular disease were included in this analysis. One-leg standing time (OLST) and handgrip strength were measured as office-based physical assessment tools, and short physical performance battery (SPPB), 6-min walk distance, and usual gait speed were also measured at hospital discharge as measurements of physical performance. All-cause mortality was assessed by death registry at the hospital. We examined the association of office-based measures with physical performance and all-cause mortality. Results: The areas under the curve of OLST for SPPB < 10, 6-min walk distance < 300 m, and usual gait speed < 1.0 m/s were 0.87 (95% CI 0.83–0.91), 0.83 (95% CI 0.80–0.86), and 0.81 (95% CI 0.78–0.85), respectively. The discrimination abilities of OLST for decreased physical performance were significantly higher than those of handgrip strength. After adjusting for the effects of patient characteristics, the hazard ratio for all-cause mortality in the < 3 s group for OLST was 1.68 (95% CI 1.06–2.67, p = 0.03). Handgrip strength, however, was not significantly associated with mortality risk in these participants. Conclusion: Short OLST, in particular < 3 s, is associated with decreased physical performance and elevated mortality risk in elderly patients with cardiovascular disease. OLST can be conveniently measured in the clinician’s office as a screening tool for impaired physical performance.

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