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

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Background:

• Cardiac rehabilitation (CR) is a crucial component of post-procedural care for patients with cardiovascular conditions.
• Aortic valve replacement, including transcatheter aortic valve replacement (TAVR), is a common procedure for which CR is recommended.
• Understanding CR participation rates and associated factors is vital for optimizing patient recovery and outcomes after TAVR.

Purpose of the Study:

• To investigate patient and hospital-level factors influencing CR participation following TAVR.
• To quantify the variation in CR participation rates across different hospitals.
• To determine if patient case mix explains the observed hospital-level disparities in CR enrollment.

Main Methods:

• A retrospective analysis linked clinical and administrative claims data for 3,372 patients who underwent TAVR.
• Data were collected from 24 hospitals in Michigan between January 2016 and June 2020.
• Sequential mixed-effects models were used to assess hospital variation in CR participation within 90 days of discharge.

Main Results:

• Only 30.6% of TAVR patients enrolled in CR within 90 days post-discharge.
• Factors negatively associated with CR participation included older age, Medicaid insurance, atrial fibrillation, dialysis, and slower walking speed.
• Significant hospital variation in CR participation was observed (5% to 60%), which was not explained by patient case mix.

Conclusions:

• Post-TAVR CR participation remains low, with substantial unexplained variation across hospitals.
• Patient characteristics alone do not account for differences in CR enrollment rates between facilities.
• Identifying and implementing effective hospital-based strategies is essential to improve CR uptake after TAVR.