Department of Rehabilitation Medicine, University of Potsdam, Faculty of Health Sciences Brandenburg, Am Neuen Palais 10, D-14469, Potsdam, Germany.
Klinik am See, Rehabilitation Center for Internal Medicine, Rüdersdorf, Germany.
BMC Cardiovasc Disord. 2020 Apr 6;20(1):158. doi: 10.1186/s12872-020-01452-x.
Aim of the study was to find predictors of allocating patients after transcatheter aortic valve implantation (TAVI) to geriatric (GR) or cardiac rehabilitation (CR) and describe this new patient group based on a differentiated characterization.
From 10/2013 to 07/2015, 344 patients with an elective TAVI were consecutively enrolled in this prospective multicentric cohort study. Before intervention, sociodemographic parameters, echocardiographic data, comorbidities, 6-min walk distance (6MWD), quality of life and frailty (score indexing activities of daily living [ADL], cognition, nutrition and mobility) were documented. Out of these, predictors for assignment to CR or GR after TAVI were identified using a multivariable regression model.
After TAVI, 249 patients (80.7 ± 5.1 years, 59.0% female) underwent CR (n = 198) or GR (n = 51). GR patients were older, less physically active and more often had a level of care, peripheral artery disease as well as a lower left ventricular ejection fraction. The groups also varied in 6MWD. Furthermore, individual components of frailty revealed prognostic impact: higher values in instrumental ADL reduced the probability for referral to GR (OR:0.49, p < 0.001), while an impaired mobility was positively associated with referral to GR (OR:3.97, p = 0.046). Clinical parameters like stroke (OR:0.19 of GR, p = 0.038) and the EuroSCORE (OR:1.04 of GR, p = 0.026) were also predictive.
Advanced age patients after TAVI referred to CR or GR differ in several parameters and seem to be different patient groups with specific needs, e.g. regarding activities of daily living and mobility. Thus, our data prove the eligibility of both CR and GR settings.
本研究旨在寻找经导管主动脉瓣植入术（TAVI）后患者分配至老年（GR）或心脏康复（CR）的预测因素，并基于差异化特征对这一新的患者群体进行描述。
2013 年 10 月至 2015 年 7 月，连续纳入 344 例接受择期 TAVI 的患者进行这项前瞻性多中心队列研究。在干预前，记录社会人口统计学参数、超声心动图数据、合并症、6 分钟步行距离（6MWD）、生活质量和虚弱（通过评估日常生活活动 [ADL]、认知、营养和移动能力的评分指数来确定）。使用多变量回归模型确定 TAVI 后分配至 CR 或 GR 的预测因素。
TAVI 后，249 例患者（80.7±5.1 岁，59.0%为女性）接受了 CR（n=198）或 GR（n=51）。GR 患者年龄更大、体力活动更少，且更常需要护理、外周动脉疾病以及左心室射血分数更低。两组在 6MWD 方面也存在差异。此外，虚弱的各个组成部分显示出预后影响：工具性 ADL 较高的值降低了被转诊至 GR 的可能性（OR：0.49，p<0.001），而移动能力受损与被转诊至 GR 呈正相关（OR：3.97，p=0.046）。临床参数如中风（OR：GR 组的 0.19，p=0.038）和 EuroSCORE（OR：GR 组的 1.04，p=0.026）也具有预测性。
TAVI 后被分配至 CR 或 GR 的老年患者在多个参数上存在差异，似乎是具有特定需求的不同患者群体，例如日常生活活动和移动能力。因此，我们的数据证明了 CR 和 GR 两种设置的适宜性。
