Impact of in-hospital cardiac rehabilitation on hospital-associated disability after transcatheter aortic valve implantation

Satoshi Katano; Yuji Kono; Toshiyuki Yano; Koshiro Kanaoka; Akinori Sawamura; Tetsufumi Motokawa; Yoshihiro Miyamoto; Yusuke Ohya; Shin-Ichiro Miura; Nagaharu Fukuma; Shigeru Makita; Hideo Izawa

doi:10.1111/jgs.19265

Impact of in-hospital cardiac rehabilitation on hospital-associated disability after transcatheter aortic valve implantation

J Am Geriatr Soc. 2024 Nov 21. doi: 10.1111/jgs.19265. Online ahead of print.

Authors

Satoshi Katano^{1

2}, Yuji Kono³, Toshiyuki Yano⁴, Koshiro Kanaoka⁵, Akinori Sawamura⁶, Tetsufumi Motokawa⁷, Yoshihiro Miyamoto⁵, Yusuke Ohya⁸, Shin-Ichiro Miura⁹, Nagaharu Fukuma¹⁰, Shigeru Makita^{11

12}, Hideo Izawa¹³

Affiliations

¹ Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan.
² Second Division of Physical Therapy, Sapporo Medical University School of Health Science, Sapporo, Japan.
³ Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan.
⁴ Department Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
⁵ Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan.
⁶ Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan.
⁷ Department of Cardiology, Nagasaki University Hospital, Nagasaki, Japan.
⁸ Department of Cardiology, University of the Ryukyus, Okinawa, Japan.
⁹ Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.
¹⁰ Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
¹¹ Department of Rehabilitation, Kawaguchi Cupola Rehabilitation Hospital, Kawaguchi, Japan.
¹² Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Japan.
¹³ Department of Cardiology, Fujita Health University, Toyoake, Japan.

PMID: 39570021
DOI: 10.1111/jgs.19265

Abstract

Background: Hospital-associated disability (HAD), a decline in the ability to perform activities of daily living (ADL) during hospitalization, is a modifiable target in integrated care for older adults. The aim of this study was to determine the impact of inpatient cardiac rehabilitation (CR) on the development of HAD in older patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI).

Methods: Older patients undergoing TAVI were extracted from the Japanese nationwide database (JROAD-DPC) from April 2014 to March 2021 and were divided into patients receiving inpatient CR (CR group) and a non-CR group. HAD was defined as a decrease in the Barthel Index (BI) score ≥5 points at discharge compared with the score at admission.

Results: Of 19,789 eligible patients, 17,066 (86%) underwent inpatient CR. The overall prevalence of HAD was 9.6%, with a lower incidence in the CR group than in the non-CR group (8.8% vs. 14.2%, p < 0.001). Random forest analysis revealed key features associated with HAD risk including BI score at admission, inpatient CR participation, age, body mass index (BMI), and chronic kidney disease. The results of multivariate logistic regression analysis showed that participation in inpatient CR was associated with a lower odds ratio (OR) of HAD (OR, 0.62; 95% confidence interval, 0.54-0.70), with similar results in inverse probability of treatment weighting-adjusted logistic regression analyses (OR, 0.82; 95% confidence interval, 0.77-0.88). Analyses in subgroups of interest showed heterogeneity in the effects of inpatient CR with possible loss in patients with a BMI of <18.5 kg/m² or a BI score of less than 60 points at admission.

Conclusions: The data suggest a beneficial effect of inpatient CR participation on the prevention of HAD in older patients undergoing TAVI, but the effect may be limited in lean patients with disability for ADL before TAVI.

Keywords: JROAD; cardiac rehabilitation; hospital‐associated disability; older patients; transcatheter aortic valve implantation.

Grants and funding

Japanese Association of Cardiac Rehabilitation