The prognostic value of Barthel index for mortality in older patients with hypertrophic cardiomyopathy: Longitudinal Prediction Study

Background Impairment of activities of daily living (ADL), assessed according to the Barthel index (BI) score, is common and associated with poor outcomes in older population. The association between impairment of ADL and the prognosis in older patients with hypertrophic myocardiopathy (HCM) has not been well studied. Methods A total of 351 older patients with HCM in our center between January 2014 and December 2017 were enrolled in this study. The clinical profile and outcomes were evaluated. According to BI score, patients were divided into three groups: total/severe dependency in ADL (≤ 60) vs. moderate dependency (65–90) vs. slight dependency/independency (95–100). Kaplan-Meier analysis and Multivariable Cox regression models were conducted to test the prognostic value of BI in older patients with HCM. Results 27(8%) patients with BI ≤ 60 vs. 48(14%) patients with BI 65–90 vs. 276(78%) patients with BI 95–100. During a follow-up of 65 ± 21 months, 72 patients died (50 cardiovascular deaths). The 5-year survival free from all-cause mortality was 48.2% (95% CI 28.7–65.2%) in patients with BI ≤ 60, 62.0% (95% CI 46.7–74.2%) in patients with BI 65–90, and 89.7% (95% CI 85.5–92.8%) in patients with BI 95–100. The 5-year survival free from cardiovascular mortality was 54.4% (95% CI 33.7–71.1%) in patients with BI ≤ 60, 69.0% (95% CI 53.2–80.4%) in patients with BI 65–90, and 94.0% (95% CI 90.4–96.3%) in patients with BI 95–100. BI was a significantly associated with all-cause mortality (hazard ratio 0.978, 95% CI 0.968–0.989, P<0.001) and cardiovascular mortality (hazard ratio 0.975, 95% CI 0.963–0.987, P<0.001). Conclusions Impairment in ADL was associated with poor outcomes in older patients with HCM, routine assessment of ADL using BI may help in decision-making and health care planning for older patients with HCM.