Barthel Index ≥ 90 before TAVR was associated with 80% 4-year survival versus 53.1% for BI < 90, significantly improving mortality prediction (C index 0.683 vs 0.626, p < 0.01).
Observational (n=475)
No
Does the Barthel Index predict long-term survival in patients undergoing TAVR for severe symptomatic aortic stenosis?
The Barthel Index is a strong discriminator of frailty that significantly improves long-term mortality prediction when combined with the STS score in patients undergoing TAVR.
Effect estimate: C index improvement from 0.626 (STS score alone) to 0.683 (combined STS and Barthel Index)
Absolute Event Rate: 80% vs 53.1%
p-value: p=<0.01
Abstract Background Transcatheter aortic valve replacement (TAVR) has become a well-established therapy for aortic stenosis (AS). With rising TAVR numbers, appropriate patient selection becomes more important. Identifying patients with the highest long-term benefit from the procedure is especially challenging in this elderly patient cohort. Barthel Index (BI) is a commonly used tool to assess the patients’ capability of activities of daily life. Methods and results In this single-center study, we analyzed BI of patients receiving TAVR for severe symptomatic AS at our center in 2018 and 2019. BI had been collected by nursing personnel during clinical routine and 475 patients could be analyzed. Median BI was 90 points and was used as cut-off to define two groups of patients: lesser frail patients with higher BI (≥ 90; n = 255) and more frail patients with lower BI (< 90; n = 220). Patients with lower BI were older (83 vs. 80 years; p < 0.01) with higher surgical risk score (STS-score 4.1% vs. 2.5%; p < 0.01), and worse renal function (CKD in 49.5% vs. 31.8%; p < 0.01). Long-term survival differed significantly: only 117 patients (53.1%) in the low BI group were still alive 4-years after TAVR vs. 204 patients (80.0%) in the higher BI group. Further analyses revealed that combining STS score and BI significantly improved mortality prediction (C index for STS score 0.626; C index for combined STS score and BI 0.683; p < 0.01). Conclusions This is the first analysis evaluating the prognostic value of BI on long-term survival after TAVR. Albeit assessing only the patient’s functional status and no detailed medical history, BI is a strong discriminator for frail patients. Moreover, it allows identification of patients at higher risk of mortality within the first 4 years after TAVR and should therefore be considered for evaluation of patients with severe AS. Graphical abstract
Haum et al. (Tue,) conducted a observational in Elderly patients (median age 81 years, interquartile range 78-85) with severe symptomatic aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) (n=475). Barthel Index assessment vs. Barthel Index < 90 versus ≥ 90 was evaluated on All-cause 4-year mortality after TAVR (C index improvement from 0.626 (STS score alone) to 0.683 (combined STS and Barthel Index), p=<0.01). Barthel Index ≥ 90 before TAVR was associated with 80% 4-year survival versus 53.1% for BI < 90, significantly improving mortality prediction (C index 0.683 vs 0.626, p < 0.01).