title: Multicomponent cardiac rehabilitation in patients after transcatheter aortic valve implantation: Predictors of functional and psychocognitive recovery.
abstract: Background In the last decade, transcatheter aortic valve implantation has become a promising treatment modality for patients with aortic stenosis and a high surgical risk. Little is known about influencing factors of function and quality of life during multicomponent cardiac rehabilitation. Methods From October 2013 to July 2015, patients with elective transcatheter aortic valve implantation and a subsequent inpatient cardiac rehabilitation were enrolled in the prospective cohort multicentre study. Frailty-Index (including cognition, nutrition, autonomy and mobility), Short Form-12 (SF-12), six-minute walk distance (6MWD) and maximum work load in bicycle ergometry were performed at admission and discharge of cardiac rehabilitation. The relation between patient characteristics and improvements in 6MWD, maximum work load or SF-12 scales were studied univariately and multivariately using regression models. Results One hundred and thirty-six patients (80.6 ± 5.0 years, 47.8% male) were enrolled. 6MWD and maximum work load increased by 56.3 ± 65.3 m ( p < 0.001) and 8.0 ± 14.9 watts ( p < 0.001), respectively. An improvement in SF-12 (physical 2.5 ± 8.7, p = 0.001, mental 3.4 ± 10.2, p = 0.003) could be observed. In multivariate analysis, age and higher education were significantly associated with a reduced 6MWD, whereas cognition and obesity showed a positive predictive value. Higher cognition, nutrition and autonomy positively influenced the physical scale of SF-12. Additionally, the baseline values of SF-12 had an inverse impact on the change during cardiac rehabilitation. Conclusions Cardiac rehabilitation can improve functional capacity as well as quality of life and reduce frailty in patients after transcatheter aortic valve implantation. An individually tailored therapy with special consideration of cognition and nutrition is needed to maintain autonomy and empower octogenarians in coping with challenges of everyday life.
authors.affiliation: 1 Centre of Rehabilitation Research, University of Potsdam, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Eichler
authors.affiliation: 1 Centre of Rehabilitation Research, University of Potsdam, Germany.
authors.forename: Annett
authors.initials: A
authors.lastname: Salzwedel
authors.affiliation: 2 Cardiological Outpatient Clinic Am Park Sanssouci, Potsdam, Germany.
authors.forename: Rona
authors.initials: R
authors.lastname: Reibis
authors.affiliation: 3 MediClin Rehabilitation Centre Spreewald, Burg, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Nothroff
authors.affiliation: 4 Sana Heart-Centre Cottbus, Cottbus, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Harnath
authors.affiliation: 5 Brandenburgklinik Berlin-Brandenburg, Bernau, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Schikora
authors.affiliation: 6 Heart Centre Brandenburg, Bernau, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Butter
authors.affiliation: 7 Department of Medical Biometry and Epidemiology, University Medical Centre, Hamburg-Eppendorf, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.affiliation: 1 Centre of Rehabilitation Research, University of Potsdam, Germany.|8 Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Völler
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D000072038:Cardiac Rehabilitation / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D003071:Cognition; D017079:Exercise Tolerance; D005260:Female; D016330:Frail Elderly; D000073496:Frailty / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D015577:Geriatric Assessment; D005858:Germany; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D026684:Personal Autonomy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000534:rehabilitation*; D016896:Treatment Outcome; D000070857:Walk Test
keywords: Cardiac rehabilitation; TAVI; exercise capacity; frailty; quality of life