Predictors of survival in patients undergoing cardiac rehabilitation after transcatheter aortic valve implantation

Franco Tarro Genta, Massimo Tidu, Paola Corbo, Francesca Bertolin, Ilaria Salvetti, Zoia Bouslenko, Andrea Giordano, Laura Dalla Vecchia

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)606-615
Number of pages10
JournalJournal of cardiovascular medicine (Hagerstown, Md.)
Volume20
Issue number9
DOIs
Publication statusPublished - Sep 2019

Keywords

  • Aged
  • Aged, 80 and over
  • Aortic Valve/diagnostic imaging
  • Aortic Valve Stenosis/diagnostic imaging
  • Biomarkers/blood
  • Cardiac Rehabilitation/adverse effects
  • Comorbidity
  • Creatinine/blood
  • Exercise Tolerance
  • Female
  • Geriatric Assessment/methods
  • Humans
  • Male
  • Prospective Studies
  • Recovery of Function
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Transcatheter Aortic Valve Replacement/adverse effects
  • Treatment Outcome
  • Walk Test

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