Butter Christian, Groß Jessica, Haase-Fielitz Anja, Sims Helen, Deutsch Cornelia, Bramlage Peter, Neuss Michael
Department of Cardiology, Heart Center Brandenburg, Bernau 16321, Germany.
Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin 16816, Germany.
J Clin Med. 2018 Oct 5;7(10):326. doi: 10.3390/jcm7100326.
The benefit of rehabilitation in elderly patients undergoing transcatheter aortic valve implantation (TAVI) for treatment of severe aortic stenosis is unknown. The impact of declining rehabilitation programs on mortality has also not been described. In a longitudinal cohort study of 1056 patients undergoing elective TAVI between 2008 and 2016, logistic regression analysis was used to assess the relationship between treatment modality and outcome according to whether or not patients participated in a three-week rehabilitation program after TAVI. Subgroup analyses included patient outcome separated according to cardiac, geriatric, or no rehabilitation. A total of 1017 patients survived until hospital discharge (96.3%) and were offered rehabilitation, 366 patients (36.0%) declined to undergo rehabilitation, with the remaining patients undergoing either cardiac ( 435; 42.8%) or geriatric rehabilitation ( = 216; 21.2%). Mortality at six months was lower for patients receiving rehabilitation compared with those who had not (adjusted odds ratio (OR): 0.49; 95% confidence interval (confidence interval [CI]: 0.25⁻0.94; = 0.032). Sub-analysis showed the benefit of cardiac (adjusted OR: 0.31; 95% CI 0.14⁻0.71, = 0.006), but not geriatric rehabilitation (adjusted OR 0.83; 95% CI 0.37⁻1.85, = 0.65). A program of rehabilitation after TAVI has the potential to reduce mortality. Future studies should focus on health-orientated behavior and identifying risk factors for declining rehabilitation programs.
经导管主动脉瓣植入术(TAVI)治疗重度主动脉瓣狭窄的老年患者康复治疗的益处尚不清楚。康复计划减少对死亡率的影响也未得到描述。在一项对2008年至2016年间接受择期TAVI的1056例患者的纵向队列研究中,根据患者TAVI后是否参加为期三周的康复计划,采用逻辑回归分析评估治疗方式与结局之间的关系。亚组分析包括根据心脏康复、老年康复或无康复情况分开的患者结局。共有1017例患者存活至出院(96.3%)并接受康复治疗,366例患者(36.0%)拒绝接受康复治疗,其余患者接受心脏康复(435例;42.8%)或老年康复(216例;21.2%)。接受康复治疗的患者六个月时的死亡率低于未接受康复治疗的患者(调整后的比值比(OR):0.49;95%置信区间(CI):0.25⁻0.94;P = 0.032)。亚分析显示心脏康复有益(调整后的OR:0.31;95% CI 0.14⁻0.71,P = 0.006),但老年康复无益(调整后的OR 0.83;95% CI 0.37⁻1.85,P = 0.65)。TAVI后的康复计划有可能降低死亡率。未来的研究应关注以健康为导向的行为,并确定康复计划减少的风险因素。