Only 4.4% of TAVI patients attended cardiac rehabilitation, which showed no significant association with reduced heart failure rehospitalisation, all-cause rehospitalisation, or mortality.
Does cardiac rehabilitation reduce unplanned HF hospital readmission in adults following transcatheter aortic valve implantation?
In a large retrospective cohort of patients undergoing TAVI, participation in cardiac rehabilitation was very low (4.4%) and was not significantly associated with reductions in HF rehospitalization or all-cause mortality.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Cardiac rehabilitation (CR) programs provide substantial benefits and are endorsed by international guidelines for various cardiac conditions, including acute coronary syndromes (ACS), heart failure (HF) and following coronary revascularisation procedures. However, evidence on CR rates and its potential benefits for patients undergoing transcatheter aortic valve implantation (TAVI) remains very limited. Purpose To characterise CR rates following TAVI procedures across England and evaluate the association between CR and patient outcomes, considering the high prevalence of frailty and comorbidities in this population. Methods Retrospective, cohort study, using whole-population electronic health records for 57 million individuals in England. Adults aged 18 years or older who underwent a TAVI procedure between 1 January 2018 and 31 March 2023 were included. Patients exposed to CR were compared to those not exposed, adjusting for demographic characteristics, clinical factors and complications with the index TAVI procedure. Primary outcome was unplanned HF hospital readmission (minimum 12-month follow-up), assessed using a competing risk analysis with death. Secondary outcomes included all-cause mortality and all-cause rehospitalisation. Results Among 24,950 individuals with a TAVI procedure (56% male, mean age 81 years and 95% white ethnicity), fewer than one in twenty attended CR (n=1,090, 4.4%). CR rates increased from 2018 (1.73 per 10,000 person days of follow-up) to 2022 (2.93 per 10,000 person days of follow-up). All-cause and HF rehospitalisation rates beyond 180 days were comparable between the exposed and unexposed groups: 49.7% (n=355) vs. 56.2% (n=8,605) for all-cause rehospitalisation and 7.4% (n=75) vs. 9.2% (n=1,995) for HF rehospitalisation. Similarly, all-cause mortality beyond 180 days did not differ between the exposed (n=300, 28.7%) and unexposed (n=7,510, 33.2%) groups. After adjustment, no significant associations were observed between exposure to CR and HF rehospitalisation, all-cause rehospitalisation, or all-cause mortality (p0.05). Conclusion The benefit of CR following TAVI remains uncertain. Given the observational nature of this study, further prospective research is required to validate these findings.
Braver et al. (Sat,) reported a other. Only 4.4% of TAVI patients attended cardiac rehabilitation, which showed no significant association with reduced heart failure rehospitalisation, all-cause rehospitalisation, or mortality.