Cardiac rehabilitation outcome after transcatheter aortic valve implantation

Penati, C.; Incorvaia, Cristoforo; Mollo, Valentina; Lietti, Federica; Gatto, Gemma; Stefanelli, Mark; Centeleghe, Paola; Talarico, Giuseppe; Mori, Ileana; Franzelli, Cristina; Ratti, Fosco; Ponticelli, Maria Paola; Ridolo, Erminia; Febo, Oreste

doi:10.4081/monaldi.2021.1621

Cited by 6 publications

(3 citation statements)

References 22 publications

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“…However, it is a strength that we screened all the patients scheduled for TAVI in our hospital, which was similar to the feasibility randomized study performed by Rogers et al [ 8 ]. Apart from the walked distance, the age of the participants in our study and several clinical features, such as the presence of comorbidities, ejection fraction, and NYHA classification were similar to those in studies investigating the effect of CR following TAVI [ 8 , 51 - 54 ].…”

Section: Discussionsupporting

confidence: 68%

Exercise-Based Real-time Telerehabilitation for Older Adult Patients Recently Discharged After Transcatheter Aortic Valve Implantation: Mixed Methods Feasibility Study

Brocki¹,

Andreasen²,

Aarøe³

et al. 2022

JMIR Rehabil Assist Technol

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Background The use of telehealth technology to improve functional recovery following transcatheter aortic valve implantation (TAVI) has not been investigated. Objective In this study, we aimed to examine the feasibility of exercise-based cardiac telerehabilitation after TAVI. Methods This was a single-center, prospective, nonrandomized study using a mixed methods approach. Data collection included testing, researchers’ observations, logbooks, and individual patient interviews, which were analyzed using a content analysis approach. The intervention lasted 3 weeks and consisted of home-based web-based exercise training, an activity tracker, a TAVI information website, and 1 web-based session with a nurse. Results Of the initially included 13 patients, 5 (40%) completed the study and were interviewed; the median age was 82 (range 74-84) years, and the sample comprised 3 men and 2 women. Easy access to supervised exercise training at home with real-time feedback and use of the activity tracker to count daily steps were emphasized by the patients who completed the intervention. Reasons for patients not completing the program included poor data coverage, participants’ limited information technology skills, and a lack of functionality in the systems used. No adverse events were reported. Conclusions Exercise-based telerehabilitation for older people after TAVI, in the population as included in this study, and delivered as a web-based intervention, does not seem feasible, as 60% (8/13) of patients did not complete the study. Those completing the intervention highly appreciated the real-time feedback during the web-based training sessions. Future studies should address aspects that support retention rates and enhance patients’ information technology skills.

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Section: Discussionsupporting

confidence: 68%

Exercise-Based Real-time Telerehabilitation for Older Adult Patients Recently Discharged After Transcatheter Aortic Valve Implantation: Mixed Methods Feasibility Study

Brocki¹,

Andreasen²,

Aarøe³

et al. 2022

JMIR Rehabil Assist Technol

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“…[48] Of note, the walked distance in our cohort at baseline was higher (median 400 m) than the distance reported in studies investigating the effects of CR following TAVI, probably because we assessed 6MWT prior to the surgery, while the assessment in most studies was performed after the surgery. [7,[9][10]15,[49][50][51] Assessing the walked distance after the surgery may be negatively influenced by inactivity or tiredness post-surgery.…”

Section: Discussionmentioning

confidence: 99%

Exercise-based real-time telerehabilitation for older patients recently discharged after transcatheter aortic valve implantation: An extended feasibility study

Brocki,

Andreasen,

Aarøe

et al. 2023

Journal of Geriatric Cardiology

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OBJECTIVES To assess the extended feasibility of a telerehabilitation program and its effects on physical performance in older adults who have recently undergone transcatheter aortic valve implantation (TAVI).METHODS In this single-center feasibility study, patients underwent an eight-week telerehabilitation program, involving webbased home exercise training twice weekly, an activity tracker, access to an informative website, and one online session with a nurse, starting one-week postoperative. Data collection was performed before surgery and three months postoperative. The feasibility of the intervention was based on recruitment and adherence to the program. As a secondary outcome, we evaluated the change in six-minute walk distance from before surgery to three months postoperative. RESULTSForty-one patients scheduled for TAVI were assessed for eligibility; 15 patients (37%) were enrolled. Of these, eight were excluded after surgery due to tiredness (n = 2), non-cardiac related hospital readmission (n = 2), fluctuating health (n = 1), death during hospital stay (n = 1), and reduced cognition (n = 2). Seven patients completed the eight-week web-based intervention and were evaluated three months postoperative. Their median (IQR) age was 83 [81, 87] years, and the sample comprised three men and four women. Their walked distance improved from median (IQR) 262 [199, 463] before surgery, to 381 [267, 521] meters three months postoperative. No adverse events were reported.CONCLUSION Web-based telerehabilitation, including supervised exercise training, in older adults who have recently undergone TAVI was feasible for a small number of patients who completed the eight-week intervention. This was reflected in an improvement in their walked distance three months after the surgery. However, the low recruitment and retention rates do question the overall feasibility of this intervention in a frail, older population of post-TAVI patients.T ranscatheter aortic valve implantation (TAVI) is the standard of care for treatment of severe aortic valve stenosis, especially in patients of old age or who are deemed to be at high perioperative mortality risk. [1,2] The benefits of TAVI are reduced mortality [3,4] and improved quality of life, [5][6][7] particularly in terms of increased mobility and usual activities of daily living. [5,8] Cardiac rehabilitation (CR) is recommended following TAVI to improve functional capacity and qu-ality of life, [9][10][11] while reducing mortality. [12] However, referral to or participation in CR in this particular population is low. [13][14][15] Cardiac telerehabilitation (CTR), defined as the use of information and communication technologies to support rehabilitation, [16,17] has proven to be as effective as center-or hospital-based CR in improving functional outcomes and reducing morbidity and mortality, [18,19] as well as improving patient activation and health literacy, [20] while being cost-effective. [21] Thus, CTR

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“…Regularly-scheduled exercises, along with other interventions, such as medications, are an established component of CR, and could significantly complement the effects of TAVR. Several studies have shown intensive post-operative recovery regimens, such as short-term exercise-based CR, especially for Phase I during hospitalization, could increase functional capacity, quality of life ( 42 – 44 ), and exercise tolerance, particularly with respect to the distance in the 6 min walk test (6MWT) ( 18 , 45 ) and maximum workload ( 46 – 48 ). These effects are coupled with lowered hospitalization lengths ( 49 ), frailty ( 50 ), anxiety, and disability.…”

Section: Cr Use In Tavrmentioning

confidence: 99%

Impact of cardiac rehabilitation on pre- and post-operative transcatheter aortic valve replacement prognoses

Zou,

Yuan,

Liu

et al. 2023

Front. Cardiovasc. Med.

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Transcatheter aortic valve replacement (TAVR) is a relatively new treatment method for aortic stenosis (AS) and has been demonstrated to be suitable for patients with varying risk levels. Indeed, among high-risk patients, TAVR outcomes are comparable to, or even better, than that of the traditional surgical aortic valve replacement (SAVR) method. TAVR outcomes, with respect to post-surgical functional capacity and quality of life, have also been found to be improved, especially when combined with cardiac rehabilitation (CR). CR is a multidisciplinary system, which integrates cardiology with other medical disciplines, such as sports, nutritional, mind-body, and behavioral medicine. It entails the development of appropriate medication, exercise, and diet prescriptions, along with providing psychological support, ensuring the cessation of smoking, and developing risk factor management strategies for cardiovascular disease patients. However, even with CR being able to improve TAVR outcomes and reduce post-surgical mortality rates, it still has largely been underutilized in clinical settings. This article reviews the usage of CR during both pre-and postoperative periods for valvular diseases, and the factors involved in influencing subsequent patient prognoses, thereby providing a direction for subsequent research and clinical applications.

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Cardiac rehabilitation outcome after transcatheter aortic valve implantation

Cited by 6 publications

References 22 publications

Exercise-Based Real-time Telerehabilitation for Older Adult Patients Recently Discharged After Transcatheter Aortic Valve Implantation: Mixed Methods Feasibility Study

Exercise-Based Real-time Telerehabilitation for Older Adult Patients Recently Discharged After Transcatheter Aortic Valve Implantation: Mixed Methods Feasibility Study

Exercise-based real-time telerehabilitation for older patients recently discharged after transcatheter aortic valve implantation: An extended feasibility study

Impact of cardiac rehabilitation on pre- and post-operative transcatheter aortic valve replacement prognoses

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