ABSTRACT
Purpose
Cardiac rehabilitation (CR) is a class I recommendation after valvular surgery. Few
data exist on the level of access to CR after surgical aortic valve replacement (SAVR),
and the factors affecting the probability of timely access to CR after SAVR have never
been empirically investigated. This study aims at estimating the proportion of SAVR
patients who initiated timely CR and understanding to what extent timely access to
CR for SAVR patients is influenced by specific characteristics of patients and hospitals.
Methods
We conducted a real-world, retrospective, population-based study by identifying from
the Italian National Hospital Discharge Records all the discharged alive SAVR patients
who accessed timely CR from 2009-2016. Two different cutoffs for timely access were
considered, i.e. one and 21 days after discharge. A unique dataset was constructed
by merging several data sources. Multiple logistic regressions were performed to identify
the factors influencing the probability to access to timely CR.
Findings
107,545 patients underwent SAVR in Italy from 2009-2016 and were discharged alive.
Overall, 71,593 SAVR patients (66.6%) accessed timely CR, with an increasing trend
over time. Additional 6,149 patients (5.7%) started CR from 2-21 days after discharge,
slightly decreasing over time. The probability of timely CR (one-day cutoff) was significantly
higher in older (OR=1.025, p<0.001) female patients (OR = 1.003, p<0.05) and patients
with cardiovascular and cerebrovascular comorbidities. Presence of rehabilitation
wards and number of rehabilitation beds in the index hospital significantly increased
the probability of timely access to CR (OR = 1.105, p<0.001 and OR = 1.006, p<0.001
respectively). Patients hospitalized in private teaching hospitals had the highest
predicted probability of timely CR after SAVR. A substantial variation in access to
CR was found across Italian regions. Similar results were obtained with the alternative
21-days cutoff.
Implications
Approximately one-third of SAVR patients did not benefit from CR in Italy, mainly
due to shortness of rehabilitation facilities, with relevant disparities across the
country. The cessation of CR services during the COVID-19 pandemic provides the opportunity
to re-think and innovate CR, shifting from center-based to home-based models. Digital
health technologies can supplement traditional health services and grant safe, effective,
and equitable access to care, especially for countries with insufficient rehabilitation
bed capacity. As CR is associated with better outcomes, we recommend decision-makers
to use our results to plan adequate healthcare services, also investing in digital
health, to ensure patients’ access to cost-effective care.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: March 03, 2022
Accepted:
February 4,
2022
Identification
Copyright
© 2022 Elsevier Inc.
