Cardiovascular outcomes of cardiac rehabilitation in cardiac valve interventions: a TriNetX global federated network study

Background and objectives Cardiac rehabilitation (CR) is an established component of secondary cardiovascular prevention. The extent to which it benefits postoperative patients remains clinically important. Accordingly, we evaluated the association between CR and clinical outcomes among patients undergoing cardiac valve interventions. Methods The TriNetX global federated research network was used to identify patients undergoing cardiac valve interventions (transcatheter aortic, pulmonary, mitral, and tricuspid valve implantation or replacement) and to compare those who subsequently received CR within 2 months with those without documented CR. The primary outcomes were 2-year composite events (death, myocardial infarction and cerebral infarction). Secondary outcomes were heart failure (HF), incident atrial fibrillation, valve prosthesis complications and dementia. The analyses were conducted with a 1-month landmark period to minimise the influence of early events. Results Before propensity-score matching (PSM), cardiac intervention patients who underwent CR (N=3,158, age:77.2 ± 8.8, 58.4% male) were more often male and had a higher prevalence of comorbidities, including hypertension, ischaemic heart disease, and diabetes mellitus, when compared with those who did not undergo CR (N=56,600, age: 76.7 ± 11.8, 56.6% male). After PSM (matched N=2,886), CR was associated with significantly lower 2-year risk of composite events (HR: 0.73, 95% CI: 0.65-0.82). In analyses restricted to aortic valve interventions, CR was associated with a lower 2-year risk of composite events (HR: 0.78, 95% CI: 0.69-0.87) and heart failure (HR: 0.64, 95% CI: 0.47-0.87). Subgroup analyses stratified by age, sex, BMI and prior myocardial infarction, as well as sensitivity analysis of aortic valve interventions performed after 2020, were in line with the primary findings for composite events. Conclusion Among patients undergoing cardiac valve interventions, initiation of CR within 2 months was associated with significantly lower 2-year risks of composite events. These findings extend prior evidence supporting the effectiveness of CR in cardiovascular diseases.