Impact of Rehabilitation on Outcomes after TAVI: A Preliminary Study

Abstract

The benefit of rehabilitation in elderly patients undergoing transcatheter aortic valve implantation (TAVI) for treatment of severe aortic stenosis is unknown. The impact of declining rehabilitation programs on mortality has also not been described. In a longitudinal cohort study of 1056 patients undergoing elective TAVI between 2008 and 2016, logistic regression analysis was used to assess the relationship between treatment modality and outcome according to whether or not patients participated in a three-week rehabilitation program after TAVI. Subgroup analyses included patient outcome separated according to cardiac, geriatric, or no rehabilitation. A total of 1017 patients survived until hospital discharge (96.3%) and were offered rehabilitation, 366 patients (36.0%) declined to undergo rehabilitation, with the remaining patients undergoing either cardiac (n = 435; 42.8%) or geriatric rehabilitation (n = 216; 21.2%). Mortality at six months was lower for patients receiving rehabilitation compared with those who had not (adjusted odds ratio (OR): 0.49; 95% confidence interval (confidence interval [CI]: 0.25–0.94; p = 0.032). Sub-analysis showed the benefit of cardiac (adjusted OR: 0.31; 95% CI 0.14–0.71, p = 0.006), but not geriatric rehabilitation (adjusted OR 0.83; 95% CI 0.37–1.85, p = 0.65). A program of rehabilitation after TAVI has the potential to reduce mortality. Future studies should focus on health-orientated behavior and identifying risk factors for declining rehabilitation programs.

Geriatric or cardiac rehabilitation? Predictors of treatment pathways in advanced age patients after transcatheter aortic valve implantation

“…In Germany, multicomponent CR represents a wellestablished treatment for the improvement of functional and psychocognitive parameters in patients after cardiac valve procedures [12][13][14][15]. For elderly patients, there is also the option of being allocated to geriatric rehabilitation (GR) instead of indication-specific rehabilitation, if there are at least two different indications to be treated.…”

Effect of cardiac rehabilitation on mortality related inflammatory markers

“…In this study the authors showed that each of PM, ET and RFM clearly reduce the hazard ratio of mortality and concluded that comprehensive CR has substantial benefits in reducing mortality and morbidity [14]. A recent study showed that elderly patients who attended a cardiac rehabilitation program after trans-catheter aortic valve implantation had decreased mortality at 6 months [15].…”

Kardiologische Rehabilitation

“…Die Evidenz von Schulungen zur Lebensstilintervention wird aufgezeigt und die Bedeutung der beruflichen Wiedereingliederung hervorgehoben [15]. [4].…”

“…In der multivariaten Analyse waren nach 7 Jahren die Gesamtmortalität um über 40 % (HR 0,5768; 95 %-CI 0,5650-0,5888; p < 0,0001) und die Rehospitalisierung um 20 % (HR 0,7997; 95 %-CI 0,7758-0,8244; p < 0,0001) in der Gruppe mit KardReha im Vergleich zu den Patienten mit "usual care" signifikant reduziert [14]. [4]. Nach 6 Monaten war das Gesamtüberleben in der Reha-Gruppe signifikant höher als in der Kontrollgruppe (95,0 % vs. 89,8 %; p = 0,003).…”

“…versorgt (17,8 vs. 9,3 %; p = 0,004), hatten eine niedrigere NYHA(New York Heart Association)-Klasse (82,0 vs. 88,7 %; p = 0,049) und einen niedrigeren logistischen Euro-Score I (16,0 vs. 19,0 %; p = 0,005), waren nach der Implantation kürzer hospitalisiert (8 vs. 10 Tage; p < 0,001) und hatten niedrigere NT-proBNP-Spiegel (1063 vs. 2562 pg/ml; p < 0,001). Insofern ist der Überlebensvorteil nicht in der Rehabilitationsform, sondern in der Auswahl der Patienten begründet [4].…”