Outpatient Cardiac Rehabilitation and Long‐Term Clinical Outcomes After Transcatheter Aortic Valve Replacement

BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become the standard treatment for severe aortic stenosis, particularly among very old adults, and long-term comprehensive management post-TAVR is becoming increasingly important. Although cardiac rehabilitation (CR) is strongly recommended for patients with heart failure (HF) or post-cardiac surgery, cohort studies evaluating the long-term efficacy of CR in patients who have undergone TAVR are scarce. This study aimed to examine the association between outpatient CR and long-term clinical outcomes post-TAVR utilizing a nationwide administrative claims database in Japan. METHODS: Among 46,885 patients who underwent TAVR between April 2014 and March 2021, 34,165 patients who participated in inpatient CR and were discharged alive were included. Patients were categorized by outpatient CR participation. After propensity score matching, the primary outcome, a composite of all-cause mortality and HF hospitalization, was compared over a 3-year period. RESULTS: Among the eligible patients, 29,552 (86.5%) were aged ≥ 80 years, and 22,805 (66.7%) were female. The participation rate in outpatient CR was 10.2%, with no observed increasing trend over the years. Advanced age, female sex, dementia, and multiple comorbidities were associated with non-participation in CR. The outpatient CR group exhibited reduced risk for the primary outcome (hazard ratio: 0.87, 95% confidence interval: 0.79-0.96) with a median follow-up of 734 days. CONCLUSIONS: The participation rate in outpatient CR after TAVR remains low, with identifiable barriers in Japan. Participation was associated with improved outcomes, suggesting a beneficial management strategy for older patients post-TAVR.