Variation in Cardiac Rehabilitation Participation During Aortic Valve Replacement Episodes of Care

Vinay Guduguntla; Jessica M Yaser; Steven J Keteyian; Francis D Pagani; Donald S Likosky; Devraj Sukul; Michael P Thompson

doi:10.1161/CIRCOUTCOMES.122.009175

Variation in Cardiac Rehabilitation Participation During Aortic Valve Replacement Episodes of Care

Circ Cardiovasc Qual Outcomes. 2022 Jul;15(7):e009175. doi: 10.1161/CIRCOUTCOMES.122.009175. Epub 2022 May 13.

Authors

Vinay Guduguntla^{1

2}, Jessica M Yaser², Steven J Keteyian³, Francis D Pagani^{4

5}, Donald S Likosky⁴, Devraj Sukul^{1

6}, Michael P Thompson^{2

4

5}

Affiliations

¹ Department of Internal Medicine, University of California, San Francisco (V.G.).
² Michigan Value Collaborative, University of Michigan, Ann Arbor (V.G., J.M.Y., M.P.T.).
³ Division of Cardiovascular Medicine, Henry Ford Health, Detroit, MI (S.J.K.).
⁴ Department of Cardiac Surgery, Michigan Medicine, Ann Arbor (F.D.P., D.S.L., M.P.T.).
⁵ Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI (F.D.P., D.S.L., M.P.T.).
⁶ Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor (D.S.).

Abstract

Background: Despite reported benefit in the setting of aortic valve replacement (AVR), cardiac rehabilitation (CR) utilization remains low, with few studies evaluating hospital and patient-level variation in CR participation. We explored determinants of CR variability during AVR episodes of care: transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR).

Methods: A cohort of 10 124 AVR episodes of care (TAVR n=5121 from 24 hospitals; SAVR n=5003 from 32 hospitals) were identified from the Michigan Value Collaborative statewide multipayer registry (2015-2019). CR enrollment was defined as the presence of a single professional or facility claim within 90 days of discharge: 93 797, 93 798, G0422, G0423. Annual trends and hospital variation in CR were described for TAVR, SAVR, and all AVR. Multilevel logistic regression was used to estimate effects of predictors and hospital risk-adjusted rates of CR enrollment.

Results: Overall, 4027 (39.8%) patients enrolled in CR, with significant differences by treatment strategy: SAVR=50.9%, TAVR=28.9% (P<0.001). CR use after SAVR was significantly higher than after TAVR and increased over time for both modalities (P<0.001). There were significant differences in CR enrollment across age, gender, payer, and some comorbidities (P<0.05). At the hospital level, CR participation rates for all AVR varied 10-fold (4.8% to 68.7%) and were moderately correlated between SAVR and TAVR (Pearson r=0.56, P<0.01).

Conclusions: Substantial variation exists in CR participation during AVR episodes of care across hospitals. However, within-hospital CR participation rates were significantly correlated across treatment strategies. These findings suggest that CR participation is the product of hospital-specific practice patterns. Identifying hospital practices associated with higher CR participation can help assist future quality improvement efforts to increase CR use after AVR.

Keywords: aortic valve; cardiac rehabilitation; episode of care; transcatheter aortic valve replacement.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Aortic Valve / surgery
Aortic Valve Stenosis* / diagnosis
Aortic Valve Stenosis* / surgery
Cardiac Rehabilitation*
Episode of Care
Heart Valve Prosthesis Implantation* / adverse effects
Humans
Risk Factors
Transcatheter Aortic Valve Replacement* / adverse effects
Treatment Outcome

Abstract

Publication types

MeSH terms

Grants and funding