Impact of outpatient cardiac rehabilitation on long-term clinical outcomes after transcatheter aortic valve replacement

Background Transcatheter aortic valve replacement (TAVR) has become the standard therapy for aortic stenosis especially for very elderly, and long-term comprehensive management after TAVR is becoming increasingly important. Although cardiac rehabilitation (CR) is strongly recommended for patients with heart failure (HF) or post-cardiac operation, there are a lack of cohort studies evaluating the long-term efficacy of outpatient CR for elderly TAVR patients. Therefore, we aimed to investigate the impact of outpatient CR on long-term outcomes after TAVR using a nationwide database in Japan. Methods In a Japanese nationwide health insurance claims database covering almost all of the Japanese population, 34,165 who received inpatient CR and were discharged were included among 47,883 patients who underwent TAVR between April 2014 and March 2021. The primary outcome with a composite of all-cause mortality and HF rehospitalization was analyzed in patients with outpatient CR participation (CR group). The secondary outcome was hospitalizations due to the conditions commonly observed in elderly patients such as pneumonia, urinary tract infection, and fracture. Results Of the included patients, 24,602 (72%) were aged 80–89 years old, and 22,805 (67%) were female. Barriers to the outpatient CR participation [3,051 patients (8.9%)] included older age [odd ratio (OR): 0.82, 95% confidence interval (CI): 0.77–0.88], female (OR 0.85, 95% CI: 0.78–0.92), and dementia (OR: 0.68, 95% CI: 0.59–0.78). The number of TAVR procedures at each facility did not influence the CR participation rate. The incidence of primary outcome was 7.5 per 100 person-years in the CR group and 8.1 per 100 person-years in the non-CR group with a median follow-up of 734 days. After covariate adjustment using weighted analysis, the CR group showed lower risks for both the primary outcome [hazard ratio (HR): 0.85, 95% CI: 0.78–0.94, P = 0.001] and the secondary outcome (HR: 0.85, 95% CI: 0.77–0.94, P = 0.002). Conclusions The participation rate of outpatient CR after TAVR was low with potential barriers, in a superaged society of Japan. However, the implementation was associated with improved outcomes, suggesting a beneficial management for post-TAVR elderly patients.