Cardiac Rehabilitation Referral After Transcatheter Aortic Valve Replacement

Abstract

Cardiac rehabilitation following transcatheter aortic valve replacement (TAVR) is associated with improved outcomes; however, it remains relatively underutilized in this patient population. As part of a quality improvement initiative, we sought to increase the rate of cardiac rehabilitation referral after TAVR at our institution. We designed and implemented a multidisciplinary program that included education of cardiothoracic surgery providers discharging post-TAVR patients on the benefits of cardiac rehabilitation with participation of cardiac rehabilitation personnel during discharge rounds with the surgical team. The study period was defined as 12 months prior to and 6 months following the implementation of the education program. Overall referral rates increased from 5% to 56% (P < 0.0001), and referrals placed before hospital discharge increased from 0.8% to 53% (P < 0.0001) over the study period. In conclusion, a combination of education regarding the benefits of cardiac rehabilitation and cardiac rehabilitation personnel participation in discharge rounds significantly increased referral to cardiac rehabilitation after TAVR.

A Systematic Review of Interventions With an Educational Component Aimed at Increasing Enrollment and Participation in Cardiac Rehabilitation

“…Overall, 13 studies were included in this review. The studies were conducted in the United States (n = 7, 54%), 19,20,[32][33][34][35][36] Canada (n = 4, 31%), 21,[37][38][39] Israel (n = 1, 8%), 40 and Switzerland (n = 1, 8%). 41 More details are presented in the PRISMA flow diagram (Figure).…”

“…Table 1 summarizes the characteristics of included studies. All studies were quantitative in design: six (31%) were randomized controlled trials 21,32,33,35,38,41 ; three (23%) were prospective cohort studies 34,36,39 ; two (15%) were quality improvement studies 19,20 ; and one each was a multicenter intervention-controlled cohort study 40 and one a pilot study, respectively (n = 1; 8%). 37 The quality appraisal of included studies is also displayed in Table 1.…”

“…Overall, 2678 adults (n = 1161; 42% women; age range: 18-76 yr) participated in the included studies. Their medical diagnoses included the following: coronary artery disease (including those with a history of myocardial infarction 21,32,33,35,36,39,41 ; coronary artery bypass surgery 32,34,35,40 ; and percutaneous coronary intervention) 35 ; acute coronary syndrome 19,37,38 ; valvular disease 20,35 ; or stable heart failure. 35 Two studies delivered the education to health care providers, including cardiothoracic surgeons and an inhospital multidisciplinary team.…”

“…35 Two studies delivered the education to health care providers, including cardiothoracic surgeons and an inhospital multidisciplinary team. 19,20 32,33,37,38 and by research team members (n = 4; 31%), 21,[39][40][41] followed by inhospital interdisciplinary teams (n = 2, 15%), 19,35 a peer advisor (n = 1, 8%), 32 CR personnel (n = 1, 8%) 20 ; a medical student (n = 1, 8%) 34 ; or physician (n = 1, 8%). 41 The delivery mode was mostly a combination of in-person and remote education (n = 6, 46%), 20,21,32,33,38,40 followed by in-person-only sessions (inhospital face-to-face orientations; n = 4, 31%), 19,36,39,41 and remote-only sessions (through telephone calls, web platforms, and printed materials delivered by mail; n = 3, 23%), 34,35,37 or a combination of both.…”

“…Noting the urgency to find solutions to extend the reach of CR services to the >80% of eligible patients who do not enroll in these programs, several studies have proposed interventions with both an educational component and quality improvement initiatives for patients and providers. [19][20][21][22][23] Therefore, the objective of this study was to systematically review the literature regarding both the effects and the characteristics of interventions with an educational component intended to increase enrollment and participation in CR among patients with CVD.…”