Evidence on cardiac rehabilitation (CR) after transcatheter aortic valve implantation (TAVI) remains limited, particularly for long-term clinical outcomes. This retrospective cohort study, published in Heart, evaluated CR participation trends across England before, during, and after the COVID-19 pandemic and examined its association with rehospitalization and mortality in patients undergoing TAVI.

Nationwide electronic health record data were analyzed to include all patients who underwent TAVI in England between 2018 and 2023. A total of 24,925 patients were evaluated (56% male; mean age 81 years), of whom only 1,090 (4.4%) attended CR. Participation declined during the first COVID-19 lockdown (1.57 per 10,000 person-days) and recovered in the post-pandemic period (3.24). Follow-up ranged up to 5 years, with a minimum of 12 months.

The primary outcome was unplanned all-cause rehospitalization, while secondary outcomes included all-cause mortality, heart failure (HF) rehospitalization, and non-cardiovascular rehospitalization. After adjustment for demographic and clinical factors, CR was associated with lower risk of all-cause rehospitalization (HR 0.88 [95% confidence interval (CI): 0.79 to 0.98; P=0.019]) and non-cardiovascular rehospitalization (HR 0.84 [95% CI: 0.76 to 0.94; P=0.002]). No association was observed between CR and HF rehospitalization (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]).

These findings highlight low CR uptake after TAVI and suggest a potential role in reducing rehospitalization, while no association with mortality or HF rehospitalization was observed.