Referral to and enrolment in cardiac rehabilitation (CR) is considered a best practice
recommendation following transcatheter aortic valve implantation (TAVI) and surgical
aortic valve replacement (sAVR). TAVI patients are underrepresented in CR and few
studies have investigated the effectiveness and completion of a structured outpatient
(phase II) CR program comparing TAVI with sAVR patients. The objectives of this study
were to: 1) compare the effectiveness of CR between TAVI and sAVR patients, and 2)
compare program completion rate between cohorts, and 3) examine predictors of program
METHODS AND RESULTS
A retrospective database review of 615 patients referred to a large, urban outpatient
CR program following TAVI (n = 158; 26%) and sAVR (n = 457; 74%) was conducted between
2015-2019. The 6-month program included aerobic and resistance training, education,
psychosocial and dietary counselling. Within-group (baseline versus discharge) and
between-group comparisons of change (peak oxygen uptake (VO2peak), body mass index,
Center for Epidemiologic Studies Depression score, and resting/peak heart rate and
systolic blood pressure), and program completion rate were examined using t-test and
chi-square analyses. Multivariable analyses were conducted to determine predictors
of program completion in all patients. Overall, 66% of patients (n = 403) referred
to CR enrolled in the program (TAVI: n = 92; 58% versus sAVR: n = 311; 68%; P = 0.03).
Of the enrolled cohorts, TAVI patients had a 55% completion rate (47/86) compared
to 61% in sAVR patients (179/295; P = 0.38). Peak oxygen uptake improved for TAVI
(15.9 ± 3.7 to 18.1 ± 4.1 mL•kg-1•min-1; P < 0.0001) and sAVR (19.4 ± 6.0 to 22.7
± 6.8 mL•kg-1•min-1; P < 0.0001) patients. No statistically significant differences
were found in other outcomes of interest. In all patients, while adjusting for VO2peak
and sex, age (80 to 70 years: OR 2.08, CI 1.32–3.30) and procedure type (TAVI to sAVR:
OR 0.47, CI 0.24–0.91), only age and procedure type were independent predictors of
Cardiac rehabilitation enrolment was significantly higher in sAVR compared to TAVI
patients; the rate of program completion did not differ significantly between the
enrolled cohorts. Program completion led to significant improvements in cardiorespiratory
fitness (VO2peak) for both groups, which can confer overall health and mortality benefits.
Regression analysis revealed age and procedure type were predictors of program completion.
Future prospective studies, targeting improved referral strategies and reducing enrolment
barriers for TAVI patients are necessary to ensure optimal patient benefit.