Key result
Lower exercise tolerance, higher Barthel Index, and higher creatinine predict 3-year mortality after TAVI rehab.
Why the study?
Outcome predictors in TAVI patients are usually based on assessments made before or at the time of TAVI without considering cardiac rehabilitation referral.
Cohort (n=95)
In patients undergoing cardiac rehabilitation after TAVI, parameters derived during rehabilitation such as exercise tolerance, Barthel Index, and serum creatinine at discharge are significant predictors of 3-year mortality.
May aid post-TAVI risk stratification during rehabilitation; hypothesis-generating and requires prospective validation before guiding care.
AIMS: Cardiac rehabilitation may improve physical and functional recovery after transcatheter aortic valve implantation (TAVI), but outcome predictors in TAVI patients are usually based on assessments made before or at the time of TAVI without regard to cardiac rehabilitation referral. We aimed to assess exercise-based cardiac rehabilitation-derived parameters that may predict 3-year outcome in TAVI patients undergoing residential cardiac rehabilitation. METHODS AND RESULTS: In 95 consecutive TAVI patients (82.7 ± 4.9 years, 65% women) who underwent a 3-week cardiac rehabilitation program, at 3-year follow-up 35 deaths occurred. Compared with survivors, nonsurvivors had longer stay in cardiac rehabilitation (29.5 ± 12.3 vs. 21.6 ± 7.5 days, P = 0.0001), worse serum creatinine at admission/discharge (1.59 ± 0.86 vs. 1.26 ± 0.43 mg/dl, P = 0.0164; 1.52 ± 0.61 vs. 1.23 ± 0.44 mg/dl, P = 0.011), higher Cumulative Illness Rated State Comorbidity Index (5.4 ± 1.5 vs. 4.6 ± 1.8, P = 0.036) and Barthel Index at admission/discharge (51.8 ± 24.5 vs. 68.1 ± 23.2, P = 0.0016; 73.5 ± 27.2 vs. 88.6 ± 15.3, P = 0.0007), higher Morse Fall Risk score (35.6 ± 24 vs. 24.3 ± 14.1, P = 0.0056), and were less likely to train above the median exercise workload (fit) (11 vs. 35%, P = 0.008) or perform the 6-min walk test (6MWT) at admission/discharge (NO-6MWT: 34 vs. 12%, P = 0.008) and walked less distance on admission (6MWT: 129.6 ± 88.3 vs. 193.3 ± 69.8 m, P = 0.008). Univariate predictors of 3-year survival were cardiac rehabilitation duration, serum creatinine, Cumulative Illness Rated State Comorbidity Index, Barthel Index and NO-6MWT at admission/discharge, 6MWT at admission, Morse Fall Risk score at discharge and fit. Multivariate analysis confirmed exercise tolerance, Barthel Index and sCr at discharge as predictors. CONCLUSION: In TAVI patients who undergo cardiac rehabilitation, lower exercise tolerance, higher Barthel Index and sCr at discharge may predict 3-year mortality.
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Genta et al. (2019) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=95). Cardiac rehabilitation-derived parameters (exercise tolerance, Barthel Index, serum creatinine) was evaluated on 3-year survival. In TAVI patients undergoing cardiac rehabilitation, lower exercise tolerance, higher Barthel Index, and higher serum creatinine at discharge were identified as predictors of 3-year mortality.
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