TOPLINE:

Cardiac rehabilitation (CR) after transcatheter aortic valve implantation (TAVI) was underutilized in England, with fewer than 1 in 20 patients attending CR between 2018 and 2023. It was further disrupted by the COVID pandemic, despite being associated with reduced risk for overall rehospitalization and for noncardiac causes.

METHODOLOGY:

• Using linked electronic health record data from five national English datasets, researchers conducted a retrospective cohort study to characterize uptake of CR following TAVI before, during, and after the COVID pandemic, and to assess its association with clinical outcomes.
• Study participants included 24,925 adults aged at least 18 years who underwent their first TAVI procedure between January 2018 and March 2023. Follow-up ranged from a minimum of 12 months to a maximum of 5 years through March 2024. The mean age was 81.5 years and 56.3% were men.
• Participants were categorized into two groups: those who were exposed to CR and those who were not. Exposure to CR was defined as at least one outpatient appointment within 180 days of discharge from their index TAVI procedure.
• The primary outcome was unplanned all-cause rehospitalization; secondary outcomes included all-cause mortality, heart failure (HF) rehospitalization, and noncardiovascular disease rehospitalization after discharge.
• Rehospitalization outcome was defined as the first unplanned rehospitalization event occurring after discharge from the index TAVI procedure.

TAKEAWAY:

• Only 4.4% of patients attended CR after TAVI. CR exposure rates increased from 1.42 per 10,000 person-days at the beginning of 2018 to 3.06 in 2023. Rates declined temporarily to 1.57 during the initial COVID lockdown (March-May 2020) and peaked to 3.24 in October-December 2022.
• Patients exposed to CR had a lower risk for unplanned all-cause rehospitalization (adjusted hazard ratio [aHR], 0.88; P = .019) and noncardiovascular rehospitalization (aHR, 0.84; P = .002) than those not exposed to CR.
• Rates of HF rehospitalization and all-cause mortality were comparable between the groups.

IN PRACTICE:

“CR across England is underutilised following TAVI procedures. CR was associated with a lower risk of all-cause and noncardiovascular rehospitalisation but not HF rehospitalisation or all-cause mortality,” the researchers of the study wrote.

SOURCE:

The study was led by Justin Braver, University of Cambridge in Cambridge, England. It was published online on April 3, in Heart.

LIMITATIONS:

Given the study’s observational design, causal inference was limited despite adjustment for a broad range of covariates. Residual confounding from previous HF hospitalization and confounding by indication may have influenced the results. Additionally, CR exposure was identified using outpatient electronic medical record data, potentially leading to misclassification bias.

DISCLOSURES:

The study received support from the British Heart Foundation - Data Science Centre, led by Health Data Research UK. One author was supported by the National Health and Medical Research Council of Australia as well as the Royal Hobart Hospital Foundation. Another author received a postgraduate research scholarship from The University of Melbourne. The authors declared no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.