Impact of Geographic Factors on Outpatient Cardiac Rehabilitation Adherence After Transcatheter Aortic Valve...

Transcatheter aortic valve implantation (TAVI) results in shorter hospital stays and earlier discharge than conventional aortic valve replacement. Postoperative cardiac rehabilitation (CR) can improve the 6-min walk distance, activities of daily living, and mental function; however, the outpatient CR (OCR) attendance rate in Japan remains low, which limits its benefits. In this study, we investigated the effect of geographic factors on OCR adherence in patients who underwent TAVI.

This single-center retrospective cohort study included 95 patients with aortic stenosis admitted for TAVI at Showa Medical University Hospital between January 2019 and December 2023. The participants were categorized into the OCR continuation and non-participation (non-OCR) groups. Primary evaluations included road distance, travel time by car, and straight-line distance to the hospital, and postoperative physical function changes. Geographic factors did not differ significantly between the 2 groups at OCR initiation. However, OCR group-restricted analysis revealed that participants who completed the 5-month OCR program had significantly shorter travel times than those who discontinued. A receiver operating characteristic curve analysis revealed that travel time by car was a significant predictor of OCR dropout (optimal cut-off 19.5 min).

This study revealed that geographic accessibility did not affect OCR initiation post-TAVI; however, it significantly impacted long-term adherence. Specifically, a travel time of >20 min led to program discontinuation.