Aim of the study was to find predictors of allocating patients after transcatheter aortic valve implantation (TAVI) to geriatric (GR) or cardiac rehabilitation (CR) and describe this new patient group based on a differentiated characterization. From 10/2013 to 07/2015, 344 patients with an elective TAVI were consecutively enrolled in this prospective multicentric cohort study. Before intervention, sociodemographic parameters, echocardiographic data, comorbidities, 6-min walk distance (6MWD), quality of life and frailty (score indexing activities of daily living [ADL], cognition, nutrition and mobility) were documented. Out of these, predictors for assignment to CR or GR after TAVI were identified using a multivariable regression model. After TAVI, 249 patients (80.7 ± 5.1 years, 59.0% female) underwent CR (n = 198) or GR (n = 51). GR patients were older, less physically active and more often had a level of care, peripheral artery disease as well as a lower left ventricular ejection fraction. The groups also varied in 6MWD. Furthermore, individual components of frailty revealed prognostic impact: higher values in instrumental ADL reduced the probability for referral to GR (OR:0.49, p < 0.001), while an impaired mobility was positively associated with referral to GR (OR:3.97, p = 0.046). Clinical parameters like stroke (OR:0.19 of GR, p = 0.038) and the EuroSCORE (OR:1.04 of GR, p = 0.026) were also predictive. Advanced age patients after TAVI referred to CR or GR differ in several parameters and seem to be different patient groups with specific needs, e.g. regarding activities of daily living and mobility. Thus, our data prove the eligibility of both CR and GR settings.

中文翻译：

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老年或心脏康复？经导管主动脉瓣植入术后高龄患者治疗途径的预测指标

该研究的目的是找到将经导管主动脉瓣植入术（TAVI）分配到老年（GR）或心脏康复（CR）后分配患者的预测因素，并根据差异性特征描述这一新的患者群体。从10/2013到07/2015，该前瞻性多中心队列研究连续入选了344例选择性TAVI患者。干预前，应记录社会人口统计学参数，超声心动图数据，合并症，6分钟步行距离（6MWD），生活质量和体弱（日常生活[ADL]的评分指标活动，认知，营养和活动能力）。其中，使用多变量回归模型确定了TAVI后分配给CR或GR的预测因子。TAVI后，有249例患者（80.7±5.1岁，女性占59.0％）接受了CR（n = 198）或GR（n = 51）。GR患者年龄较大，体力活动较少，更常受到护理，外周动脉疾病以及左心室射血分数降低。这些组的6MWD也有所不同。此外，体弱的各个组成部分也显示出对预后的影响：工具性ADL值较高会降低转诊GR的可能性（OR：0.49，p <0.001），而活动能力减退与转介GR正相关（OR：3.97，p = 0.046）。临床参数如中风（OR：GR为0.19，p = 0.038）和EuroSCORE（OR：GR为1.04，p = 0.026）也是可预测的。TAVI后被称为CR或GR的高龄患者在几个参数上有所不同，并且似乎是具有特定需求的不同患者组，例如关于日常生活和活动能力的患者。因此，我们的数据证明了CR和GR设置均符合条件。