Division of Cardiac Rehabilitation, IRCCS Maugeri Clinical Scientific Institutes, Turin, Italy -
Division of Cardiac Rehabilitation, IRCCS Maugeri Clinical Scientific Institutes, Veruno, Novara, Italy.
Panminerva Med. 2023 Jun;65(2):220-226. doi: 10.23736/S0031-0808.22.04444-5. Epub 2022 Mar 22.
The aim of this study was to evaluate cardiac rehabilitation (CR)-derived predictors of outcome in patients discharged from rehabilitation after transcatheter aortic valve replacement (TAVR).
We retrospectively analyzed data from 232 TAVR patients (aged 82±6 years, 55% females) discharged following an average 3-week residential CR program in the period January 2009 to December 2017. Comorbidities (cumulative illness rated state-comorbidity index, CIRS-CI), echocardiography on admission, disability (Barthel Index [BI]) and functional capacity (6-min walk distance, 6MWD) at discharge, and maximal training session intensity expressed in METs/min were collected. The endpoint was all-cause mortality.
Seventy-four (32%) deaths occurred at 3-year follow-up. At discharge, non-survivors had a higher comorbidity rate (CIRS-CI 5.2±2.3 vs. 4.1±1.9, P=0.000), higher disability level (BI 80.4±24 vs. 88.8±17, P=0.000), and worse renal function (creatinine 1.6±0.9 vs. 1.2±0.4 mg/dL, P=0.000). They were also more often on diuretics (73% vs. 53.2%, P=0.003) and beta-blocker therapy (73% vs. 57.6%, P=0.042) and had a markedly reduced functional capacity (6MWD 221±100m vs. 265±105m, P=0.001). At multivariate Cox proportional hazards regression analysis, independent predictors of survival at follow-up were lower comorbidity rate, a better-preserved renal function, lower use of diuretics, and a higher 6MWD at discharge (Harrell's C = 0.707).
Patients attending residential CR after TAVR are very old with significant comorbidity. The overall 3-year mortality rate after CR discharge is high. Our findings suggest the need for individually tailored follow-up care in patients discharged from CR after TAVR to address their residual exercise capacity, comorbidities, and renal function impairment.
本研究旨在评估经导管主动脉瓣置换术（TAVR）后接受康复治疗出院患者的心脏康复（CR）相关预后预测因素。
我们回顾性分析了 2009 年 1 月至 2017 年 12 月期间在平均为期 3 周的住院 CR 项目后出院的 232 例 TAVR 患者（年龄 82±6 岁，55%为女性）的数据。收集合并症（累积疾病评分状态-合并症指数，CIRS-CI）、入院时的超声心动图、出院时的残疾（巴氏指数[BI]）和功能能力（6 分钟步行距离，6MWD）以及以 METs/min 表示的最大训练强度。终点为全因死亡率。
在 3 年随访时，有 74 例（32%）死亡。出院时，存活组的合并症发生率更高（CIRS-CI 5.2±2.3 vs. 4.1±1.9，P=0.000），残疾水平更低（BI 80.4±24 vs. 88.8±17，P=0.000），肾功能更差（肌酐 1.6±0.9 vs. 1.2±0.4mg/dL，P=0.000）。他们更常服用利尿剂（73% vs. 53.2%，P=0.003）和β受体阻滞剂（73% vs. 57.6%，P=0.042），且功能能力明显降低（6MWD 221±100m vs. 265±105m，P=0.001）。多变量 Cox 比例风险回归分析显示，随访时生存的独立预测因素为较低的合并症发生率、较好的肾功能保留、较低的利尿剂使用率和出院时较高的 6MWD（Harrell's C=0.707）。
接受 TAVR 后进行住院 CR 的患者年龄非常大，且合并症显著。CR 出院后 3 年总体死亡率很高。我们的研究结果表明，需要对 TAVR 后从 CR 出院的患者进行个性化的随访护理，以解决他们的剩余运动能力、合并症和肾功能损害问题。
