Barthel index in TAVR patients - a novel use of an old score

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.

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).

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.