Association of Cardiac Rehabilitation With Decreased Hospitalization and Mortality Risk After Cardiac Valve Surgery

Abstract

IMPORTANCE National guidelines recommend cardiac rehabilitation (CR) after cardiac valve surgery, and CR is covered by Medicare for this indication. However, few data exist regarding current CR enrollment after valve surgery.OBJECTIVE To characterize CR enrollment after cardiac valve surgery and its association with outcomes, including hospitalizations and mortality. DESIGN, SETTING, AND PARTICIPANTS This cohort study of patients undergoing valve surgery was conducted in calendar year 2014, with follow-up through 2015. The study included all fee-for-service Medicare beneficiaries undergoing open cardiac valve surgery in 2014. Patients identified by inpatient diagnosis codes for open aortic, mitral, tricuspid, and pulmonary valve surgery were included. Data analysis occurred from January 2018 to March 2019. EXPOSURES Logistic regression was used to evaluate sociodemographic and clinical factors associated with CR enrollment. MAIN OUTCOMES AND MEASURES We used Andersen-Gill models to evaluate the association of CR enrollment with 1-year hospitalization risk and Cox regression models to evaluate the association of CR enrollment with 1-year mortality risk. RESULTS A total of 41 369 Medicare beneficiaries (median [interquartile range] age, 73 [68-79] years; 16 935 [40.9%] female) underwent open valve surgery in the United States in 2014. Fewer than half of patients (17 855 [43.2%]) who had valve surgery enrolled in CR programs. Several racial/ethnic groups had lower odds of enrolling in CR programs after valve surgery compared with white patients, including Asian patients (odds ratio [OR], 0.36 [95% CI, 0.28-0.47]), black patients (OR, 0.60 [95% CI, 0.54-0.67]), and Hispanic patients (OR, 0.36 [95% CI, 0.28-0.46]). Patients undergoing concomitant coronary artery bypass grafting had higher odds of CR enrollment (OR, 1.26 [95% CI,) than those without the concomitant coronary artery bypass graft procedure, as did patients in the Midwest census region (OR, 2.40 [95% CI, 2.28-2.54]) compared with those in the South (reference). Cardiac rehabilitation enrollment was associated with fewer hospitalizations within 1 year of discharge (hazard ratio, 0.66 [95% CI, 0.63-0.69] after multivariable adjustment). Enrollment was also associated with a 4.2% absolute decrease in 1-year mortality risk (hazard ratio, 0.39 [95% CI, 0.35-0.44] after multivariable adjustment).CONCLUSIONS AND RELEVANCE Fewer than half of Medicare beneficiaries undergoing cardiac valve surgery enroll in CR programs, and there are marked racial/ethnic disparities among those that do. Cardiac rehabilitation is associated with decreased 1-year cumulative hospitalization and mortality risk after valve surgery. These results invite further study on barriers to CR enrollment in this population.

Effect of a pragmatic home-based mobile health exercise intervention after transcatheter aortic valve replacement: a randomized pilot trial

“…Centre-based CR for individuals who have experienced a cardiovascular hospitalization or undergone a cardiovascular procedure is associated with improved survival and lower rates of rehospitalization. 6 , 7 Indeed, the magnitude of the benefit that comes from participation in CR exceeds many expensive drugs and procedures in medicine. For example, a recent analysis of Medicare patients undergoing cardiac valve surgery showed that CR participation was associated with a 61% relative decrease and 4.2% absolute decrease in 1-year mortality risk and a 34% reduction in the relative risk of rehospitalization.…”

“… 5 A recent report on cardiac rehabilitation (CR) after valve surgery showed that although CR was associated with reduced rehospitalization and mortality in the first year after the surgery, participation rates were only 43%. 6 While the literature demonstrates similar associations between CR and reduced mortality among patients treated for coronary artery disease, rates of participation are even lower. 7 , 8 Participation in CR after TAVR has not been studied.…”

The impact of additional resistance and balance training in exercise-based cardiac rehabilitation in older patients after valve surgery or intervention: randomized control trial

“…Sufficient evidence-based data on adverse events, mortality, quality of life, symptoms and reversible left ventricular remodeling are not yet available [5]. A recently published large American cohort study demonstrated CR participation to be associated with reduction in hospital admissions and mortality rate within the first year after CR completion [8]. However, there are no generally accepted and evaluated standards for the content, mode, volume, and intensity of exercise-based CR after valve surgery or intervention [1,2].…”

Kardiologische Rehabilitation

“…Die Reduktion der Mortalität war gleich zwischen den Gruppen mit/ohne begleitende ACB-Op. und unabhängig davon, ob die KardReha sofort nach Operation oder erst später begonnen wurde [7].…”