Abstract

Transcatheter aortic value replacement (TAVR) patients tend to be older, frail, and have one or more comorbidities. Cardiac rehabilitation is essential to returning these patients to their pre-intervention level of activity and functioning. However, once outpatient (Phase 2) rehabilitation has been completed, most remain patients at elevated risk for serious adverse events, notably falling, that impact their prognosis for meaningful recovery and resumption of an active lifestyle. Home-based cardiac rehabilitation (Phase 3) is elective and often is either not prescribed or haphazardly programmed, and consequently it has received relatively little research and formal practice attention or utilization. This manuscript examines how and why the incorporation of a structured, Phase 3 program for training patients to independently recover from an accidental fall into standard cardiac rehabilitation practice would enhance cardiologists’ ability to improve their post-TAVR patients’ long-term clinical and functional outcomes as well as quality of life. A model is proposed for a physician-prescribed and -supervised Phase 3 fall recovery program that maximizes patient access and participation while ensuring quality and consistency. This functional fall recovery model program comprises three components: (1) prognostic screening and assessment tools; (2) a specific fall recovery maneuver and supporting exercises; and (3) performance and outcome metrics, not only for clinical application but also to comparatively utilize in research studies of fall recovery methods. Each of these components can be delivered either in person, virtually/remotely or a hybrid by cardiac rehabilitation nurses or other qualified staff.