Participation in outpatient rehabilitation is associated with reduced readmission rates in patients with acute aortic dissection
Authors: Shibuya M , Hamazaki N , Kobayashi S , Ichikawa T , Kariya H , Uchida S , Noda T , Ueno K , Maekawa E , Meguro K , Kamiya K , Matsunaga A , Kitamura T , Ako J , Miyaji K 
Published: November 2023

Abstract

Background
Patients with acute aortic dissection (AAD) usually require a restriction of physical activity during hospitalisation, which frequently causes difficulty returning to their daily life. Additionally, the increase in the number of older patients with AAD, especially those with frailty, is a crucial problem to worsen clinical outcomes after medical and surgical treatment. Conversely, outpatient cardiovascular rehabilitation is recognized to improve physical function and reduce readmission rates in patients with heart diseases. Although several studies have documented the safety of physical activity intervention after AAD, the relationship between outpatient cardiovascular rehabilitation and clinical outcomes has not been thoroughly evaluated.

Purpose
This study aimed to examine whether outpatient cardiovascular rehabilitation is associated with clinical outcomes, including readmission rates and mortality, in patients with AAD.

Methods
This was a single-centre cohort study. We included the patients admitted to a tertiary hospital for treatment of AAD and who received cardiovascular rehabilitation during hospitalisation. Patient characteristics during hospitalisation included age, sex, body mass index, type of AAD as the Stanford classification, treatment information, and comorbidities. We also reviewed whether or not the patients participated in outpatient cardiovascular rehabilitation after discharge. The primary and secondary endpoints were readmission due to cardiovascular disease and all-cause death, respectively. We compared the differences in patient characteristics between the participation in outpatient rehabilitation. The Kaplan–Meier method with log-rank test and multivariate Cox regression analysis were used to examine the association of outpatient rehabilitation participation with the incidences of readmission and death.

Results
Among the 323 studied patients, 163 participated in outpatient rehabilitation, and 160 did not in. Participants in outpatient rehabilitation showed rates of higher surgical treatment and lower diabetes mellitus as compared with non-participants. There was a significant association between participation in outpatient rehabilitation and lower readmission rates (log-rank: P = 0.045, Figure 1). However, this association was not observed in all-cause death (log-rank: P = 0.063). After adjusting for patient characteristics as confounders, outpatient rehabilitation was significantly associated with lower readmission rates (adjusted hazard ratio [aHR]: 0.63, 95% confidence interval [CI]: 0.41–0.97) and with a tendency of low all-cause death without statistical significance (aHR: 0.51, 95% CI: 0.23–1.10).

Conclusions
In patients with AAD, participation in outpatient cardiovascular rehabilitation may be beneficial to reduce readmission rates after hospital discharge. Our findings suggest outpatient cardiovascular rehabilitation is one of the treatment options to improve clinical outcomes in these patients.