{
  "abstract": "Background Evidence on cardiac rehabilitation (CR) after transcatheter aortic valve implantation (TAVI) is limited. We examined CR participation across England before, during and after the COVID-19 pandemic, and its association with clinical outcomes.Methods This retrospective cohort study used whole-population electronic health records to evaluate characteristics and outcomes of all TAVI recipients in England (2018–2023), stratified by CR participation. The primary outcome was unplanned all-cause rehospitalisation. Secondary outcomes included all-cause mortality, heart failure (HF) rehospitalisation and non-cardiovascular rehospitalisation. Follow-up was up to 5 years, with a minimum of 12 months. Multivariable models adjusted for demographics, clinical factors and procedural complications.Results Among 24 925 TAVI recipients (56% male, mean age 81 years and 95% white ethnicity), only 1090 (4.4%) attended CR. CR rates dropped during the first COVID-19 lockdown (1.57 per 10 000 person-days) and recovered post pandemic (3.24). HF rehospitalisation rates per 10 000 person-days were similar between CR and non-CR groups (1.05 vs 1.02), while all-cause (4.49 vs 4.72), non-cardiovascular rehospitalisation (4.53 vs 4.82) and mortality rates (3.61 vs 3.84) were slightly lower among CR participants. After adjustment, CR was associated with lower risk of all-cause (HR 0.88, 95% CI 0.79 to 0.98; p=0.019) and non-cardiovascular rehospitalisation (HR 0.84, 95% CI 0.76 to 0.94; p=0.002); however, there was no evidence of an association between CR and HF rehospitalisation (HR 0.94, 95% CI 0.75 to 1.19; p=0.607) or mortality (HR 0.95, 95% CI 0.84 to 1.07; p=0.383).Conclusion CR after TAVI declined during the first COVID-19 lockdown but rebounded quickly. CR was associated with lower all-cause and non-cardiovascular rehospitalisation but was not associated with lower HF rehospitalisation or mortality. More research is needed to confirm these clinical findings.",
  "authors": [
    {
      "affiliations": [
        "Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK",
        "Baker Department of Cardiometabolic Health, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia"
      ],
      "name": "Justin Braver"
    },
    {
      "affiliations": [
        "Baker Department of Cardiometabolic Health, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia",
        "Imaging Research Lab, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia"
      ],
      "name": "Thomas H Marwick"
    },
    {
      "affiliations": [
        "British Heart Foundation Data Science Centre, Health Data Research UK, London, UK"
      ],
      "name": "John Nolan"
    },
    {
      "affiliations": [
        "Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK",
        "British Heart Foundation Data Science Centre, Health Data Research UK, London, UK"
      ],
      "name": "Carmen Petitjean"
    },
    {
      "affiliations": [
        "Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK",
        "British Heart Foundation Data Science Centre, Health Data Research UK, London, UK"
      ],
      "name": "Angela M Wood"
    },
    {
      "affiliations": [],
      "name": "On behalf of the CVD-COVID-UK/COVID-IMPACT Consortium"
    }
  ],
  "title": "Cardiac rehabilitation after transcatheter aortic valve implantation before, during and after the COVID-19 pandemic: a whole-population study",
  "uid": "140b1b98-71ba-5ae8-9c98-632b4813484f"
}