Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 16;2(8):100581.
doi: 10.1016/j.jacadv.2023.100581. eCollection 2023 Oct.

Predictors and Variation in Cardiac Rehabilitation Participation After Transcatheter Aortic Valve Replacement

Devraj Sukul  1   2   3 , Jeremy Albright  1 , Michael P Thompson  3   4   5 , Pedro Villablanca  6 , Steven J Keteyian  6 , Jessica Yaser  5 , Duane Berkompas  7 , Alphonse DeLucia  8 , Himanshu S Patel  4 , Stanley J Chetcuti  1 , P Michael Grossman  1   2
Affiliations

Predictors and Variation in Cardiac Rehabilitation Participation After Transcatheter Aortic Valve Replacement

Devraj Sukul et al. JACC Adv. .

Abstract

Background: Cardiac rehabilitation (CR) is strongly recommended for a spectrum of cardiovascular conditions and procedures including aortic valve replacement.

Objectives: The purpose of this study was to characterize patient and hospital factors associated with CR participation after transcatheter aortic valve replacement (TAVR) and determine which factors explain hospital-level variation in CR participation.

Methods: We linked clinical and administrative claims data from patients who underwent TAVR at 24 Michigan hospitals between January 1, 2016 and June 30, 2020 and obtained rates of CR enrollment within 90 days of discharge. Sequential mixed models were fit to evaluate hospital variation in 90-day post-TAVR CR participation.

Results: Among 3,372 patients, 30.6% participated in CR within 90-days after discharge. Several patient factors were negatively associated with CR participation after TAVR including older age, Medicaid insurance, atrial fibrillation/flutter, dialysis use, and slower baseline 5-m walk times. There was substantial hospital variation in CR participation after TAVR ranging from 5% to 60% across 24 hospitals. Patient case mix did not explain hospital variation in CR across hospitals with median OR numerically increasing from 2.11 (95% CI: 1.62-2.67) to 2.13 (95% CI: 1.61-2.68) after accounting for patient-level factors.

Conclusions: Less than 1 in 3 patients who underwent TAVR in Michigan participated in CR within 90-days of discharge. Although several patient factors are associated with CR participation, hospital-level variation in CR participation after TAVR is not explained by patient case mix. Identifying hospital processes of care that promote CR participation after TAVR will be critical to improving CR participation after TAVR.

Keywords: TAVR; cardiac rehabilitation; health services research; hospital variation.

PubMed Disclaimer

Conflict of interest statement

Support for the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) and the Michigan Value Collaborative (MVC) is provided by 10.13039/100001502Blue Cross Blue Shield of Michigan as part of the Blue Cross Blue Shield of Michigan Value Partnerships program; however, the opinions, beliefs and viewpoints expressed by the authors do not necessarily reflect those of Blue Cross Blue Shield of Michigan or any of its employees. Drs Sukul and Albright have received salary support from the Blue Cross Blue Shield of Michigan for their role in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Dr Thompson has received salary support from Blue Cross Blue Shield of Michigan for his role with the Michigan Value Collaborative and receives funding from the 10.13039/100000133Agency for Healthcare Research and Quality (K01HS027830). Drs Patel, Chetcuti, and Grossman have received salary support for their role in the Michigan Structural Heart Consortium. Dr Villablanca is a consultant for Edwards, Teleflex, and Angiodynamics; and a proctor for Edwards. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Yearly Rates of 90-Day CR Participation After TAVR: 2016 to Quarter 2 of 2020 CR = cardiac rehabilitation; TAVR = transcatheter aortic valve replacement.
Figure 2
Figure 2
Unadjusted Rates of CR Participation Across STS Risk Score, Baseline KCCQ Overall Score, and Baseline 5-m Walk Time The Society of Thoracic Surgeons predicted risk of mortality is stratified into low risk (<4%), intermediate risk (≥4%-<8%), and high risk (≥8%). Baseline Kansas City Cardiomyopathy Questionnaire overall scores and 5-m walk times were stratified into quartiles. CR = cardiac rehabilitation; KCCQ = Kansas City Cardiomyopathy Questionnaire; STS = Society of Thoracic Surgeons.
Central Illustration
Central Illustration
Select Patient Predictors of CR Participation After TAVR and Hospital Variation in 90-Day CR Participation CR = cardiac rehabilitation; Hgb = hemoglobin (g/dL); TAVR = transcatheter aortic valve replacement.
Figure 3
Figure 3
Patient Demographic, Socioeconomic, Clinical, and Hospital Factors Associated With CR Participation The central black circles represent the point estimates for the adjusted odds ratios with corresponding 95% confidence intervals (horizontal black lines). AF = atrial fibrillation; AFL = atrial flutter; CABG = coronary artery bypass graft; CR = cardiac rehabilitation; DCI = Distresses Communities Index; KCCQ-12 = 12-item Kansas City Cardiomyopathy Questionnaire; PAD = peripheral artery disease; PC = principal component; PCI = percutaneous coronary intervention; TIA = transient ischemic attack.
See this image and copyright information in PMC

References

    1. Levine G.N., Bates E.R., Blankenship J.C., et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58:e44–122. - PubMed
    1. Piepoli M.F., Hoes A.W., Agewall S., et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR) Eur Heart J. 2016;37:2315–2381. - PMC - PubMed
    1. David H.L., Smith Peter K., Anderson Jeffrey L., et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery. J Am Coll Cardiol. 2011;58(24):e123–e210. - PubMed
    1. Ades P.A. Cardiac rehabilitation and secondary prevention of coronary heart disease. N Engl J Med. 2001;345:892–902. - PubMed
    1. Anderson L., Oldridge N., Thompson D.R., et al. Exercise-based cardiac rehabilitation for coronary heart disease: cochrane systematic review and meta-analysis. J Am Coll Cardiol. 2016;67:1–12. - PubMed

LinkOut - more resources