Dec. 23--For years, Dr. Seiichi Noda has carefully watched patients walk from the waiting room into the examining room and asked himself a specific set of questions:
-- How fast is their gait?
-- Is their grip strong when they shake hands?
-- Can they climb onto the exam table without assistance?
-- Are they able to hold a conversation longer than five minutes without getting winded?
Making note of such physical markers helps Noda, a cardiothoracic surgeon with the SSM Heart Institute, determine how well patients will tolerate heart surgery.
He's not the only doctor who does this. It's been common practice for years, he said. And now there's scientific data to support its efficacy.
A study published in the November issue of The Journal of the American College of Cardiology found that measuring gait speed is a simple, effective means of predicting mortality and major morbidity in elderly patients about to undergo cardiac surgery.
The study, which was lead by Jonathan Afilalo, a cardiologist at Jewish General Hospital at McGill University in Montreal, looked at 131 patients, age 70 and older, who were scheduled for coronary artery bypass and valve replacement or repair between 2008 and 2009.
Sixty of the patients (46 percent) were classified as slow walkers before surgery, because it took them more than six seconds to walk five meters, or about 15 feet. Thirty of those 60 slow-gait patients either died after surgery or experienced long-term issues that required discharging them to a health care facility for ongoing medical care or rehabilitation. That's three times higher than the rate of mortality or morbidity in patients who were able to walk the 15 feet in six seconds or less.
Women who had diabetes and a slow gait ran a particularly high risk for a poor outcome.
"It's actually putting some objectivity and science behind something that we always did intuitively," Noda said.
The gait test is among a growing number of old-school techniques that doctors are using to assess patients.
Dr. George Griffing, professor of internal medicine at St. Louis University Medical School, pulls out a ruler -- or a yardstick as the case may be -- to measure the height of patients' bellies when they lie flat on their backs on an exam table.
A measurement of more than 10 inches in women and more than 12 inches in men indicates that they have excess deep-belly fat and triples their risk for cardiovascular disease and type 2 diabetes. Ongoing research bolsters that belief, too.
Sometimes, Noda will clip an inexpensive pulse oximeter onto a patient's finger and have her walk around the office for several minutes to measure her oxygen levels during exertion.
"In this era of Obamacare, I think we might see a trend going back toward these very basic studies rather than ordering high-tech tests," Noda said.
He stresses that just because a patient has a slow gait doesn't mean he won't have the surgery. But such tests might give doctors an opportunity to delay surgery in order to get their patients stronger through diet and exercise. Or, they might admit the patient into the hospital rather than doing outpatient surgery. And at the very least, Noda said, "it allows us to talk to the patient and their family and tell them what we can realistically expect to see after surgery."
It also allows them to weigh a patient's current quality of life against the potential outcome.
For instance, Noda said, he's treating an 85-year-old woman who has a mitro-valve leak and lives on her own.
"We want to make 100 percent sure she will get a meaningful recovery, which means that she'll be self-sufficient again," he said. "Her problem now is that she can't go to church or walk around without getting out of breath. Her quality of life is suffering."
She was, however, able to do the gait test easily and was also able to hold a five-minute conversation. So Noda scheduled her for surgery.
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