Predictors of survival in patients undergoing cardiac rehabilitation after transcatheter aortic valve replacement (TAVR): a multicenter retrospective study

BACKGROUND: The aim of this study was to evaluate cardiac rehabilitation (CR)-derived predictors of outcome in patients discharged from rehabilitation after transcatheter aortic valve replacement (TAVR).METHODS: We retrospectively analyzed data from 232 TAVR patients (aged 82 & PLUSMN;6 years, 55% females) discharged following an average 3-week residential CR program in the period January 2009 to December 2017. Comorbidities (cumulative illness rated state-comorbidity index, CIRS-CI), echocardiography on admission, disability (Barthel Index [BI]) and functional capacity (6-min walk distance, 6MWD) at discharge, and maximal training session intensity expressed in METs/min were collected. The endpoint was all-cause mortality. RESULTS: Seventy-four (32%) deaths occurred at 3-year follow-up. At discharge, non-survivors had a higher comorbidity rate (CIRS-CI 5.2 & PLUSMN;2.3 vs. 4.1 & PLUSMN;1.9, P=0.000), higher disability level (BI 80.4 & PLUSMN;24 vs. 88.8 & PLUSMN;17, P=0.000), and worse renal function (creatinine 1.6 & PLUSMN;0.9 vs. 1.2 & PLUSMN;0.4 mg/dL, P=0.000). They were also more often on diuretics (73% vs. 53.2%, P=0.003) and beta-blocker therapy (73% vs. 57.6%, P=0.042) and had a markedly reduced functional capacity (6MWD 221 & PLUSMN;100m vs. 265 & PLUSMN;105m, P=0.001). At multivariate Cox proportional hazards regression analysis, independent predictors of survival at follow-up were lower comorbidity rate, a better-preserved renal function, lower use of diuretics, and a higher 6MWD at discharge (Harrell's C = 0.707).CONCLUSIONS: Patients attending residential CR after TAVR are very old with significant comorbidity. The overall 3-year mortality rate after CR discharge is high. Our findings suggest the need for individually tailored follow-up care in patients discharged from CR after TAVR to ad-dress their residual exercise capacity, comorbidities, and renal function impairment.

Automated summary

This study evaluated CR-derived predictors of outcome in patients discharged after TAVR. Non-survivors at discharge had higher comorbidity rate, worse disability and renal function, and reduced functional capacity. Independent predictors of survival included lower comorbidity rate, better-preserved renal function, lower use of diuretics, and higher functional capacity at discharge.