Cardiac rehabilitation after transcatheter aortic valve implantation before, during and after the COVID-19 pandemic: a whole-population study

BACKGROUND: Evidence on cardiac rehabilitation (CR) after transcatheter aortic valve implantation (TAVI) is limited. We examined CR participation across England before, during and after the COVID-19 pandemic, and its association with clinical outcomes. METHODS: This retrospective cohort study used whole-population electronic health records to evaluate characteristics and outcomes of all TAVI recipients in England (2018-2023), stratified by CR participation. The primary outcome was unplanned all-cause rehospitalisation. Secondary outcomes included all-cause mortality, heart failure (HF) rehospitalisation and non-cardiovascular rehospitalisation. Follow-up was up to 5 years, with a minimum of 12 months. Multivariable models adjusted for demographics, clinical factors and procedural complications. RESULTS: Among 24 925 TAVI recipients (56% male, mean age 81 years and 95% white ethnicity), only 1090 (4.4%) attended CR. CR rates dropped during the first COVID-19 lockdown (1.57 per 10 000 person-days) and recovered post pandemic (3.24). HF rehospitalisation rates per 10 000 person-days were similar between CR and non-CR groups (1.05 vs 1.02), while all-cause (4.49 vs 4.72), non-cardiovascular rehospitalisation (4.53 vs 4.82) and mortality rates (3.61 vs 3.84) were slightly lower among CR participants. After adjustment, CR was associated with lower risk of all-cause (HR 0.88, 95% CI 0.79 to 0.98; p=0.019) and non-cardiovascular rehospitalisation (HR 0.84, 95% CI 0.76 to 0.94; p=0.002); however, there was no evidence of an association between CR and HF rehospitalisation (HR 0.94, 95% CI 0.75 to 1.19; p=0.607) or mortality (HR 0.95, 95% CI 0.84 to 1.07; p=0.383). CONCLUSION: CR after TAVI declined during the first COVID-19 lockdown but rebounded quickly. CR was associated with lower all-cause and non-cardiovascular rehospitalisation but was not associated with lower HF rehospitalisation or mortality. More research is needed to confirm these clinical findings.