Transition to Cardiac Rehabilitation (T2CR) to Address Barriers of Multimorbidity and Frailty
VA Office of Research and Development
250 participants
Nov 1, 2024
INTERVENTIONAL
Conditions
Summary
Cardiac rehabilitation (CR) is a secondary prevention program for patients with cardiovascular disease (CVD). It is especially valuable as CVD increasingly occurs in combination with comorbidity, frailty, and complexities of care that predispose patients to functional decline, disability, and high costs. Still, few Veterans participate in CR, in part because of the difficult logistics to attend. Promising Practice home-based CR (HBCR) was developed to increase CR participation, but many Veterans remain too limited by comorbidity and frailty for participation. A Transition to CR (T2CR) intervention is a face-to-face program that fosters vital skills, education, insights, motivation, and patient-provider relationships conducive to successful HBCR thereafter. This study compares Veterans eligible for CR who are randomized to T2CR intervention versus usual care. Differences in functional capacity, HBCR participation, and healthy days at home are compared over one year. Patients' experiences and providers' perspectives of barriers and facilitators to T2CR are also compared.
Eligibility
Inclusion Criteria7
- Eligible candidates will consist of male and female Veterans hospitalized with:
- ischemic heart disease (acute myocardial infarction or stable ischemia)
- revascularization (coronary artery bypass grafting or percutaneous coronary intervention)
- valvular heart disease (surgical or percutaneous intervention for mitral regurgitation or aortic stenosis)
- or heart failure (with reduced or preserved ejection fraction)
- All will be recruited while initially hospitalized and must express willingness to consider cardiac rehabilitation as a treatment option, including the possibility of the intervention which could possibly extend the length of their hospitalization (for 2 days maximum).
- Study candidates must also be English speaking and able to provide written informed consent
Exclusion Criteria5
- Veterans with unstable medical condition as indicated by history, physical exam, and/or laboratory findings end-stage disease likely to be fatal within 12 months
- severe cognitive impairment (MiniCog score 0-2)
- history of addictive or behavioral issues that confound safe administration of HBCR
- hearing loss that interferes with participation in the trial
- living in a long-term care living situation prior to the time of hospitalization, no plans to return to independent living after the hospitalization
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Interventions
The T2CR intervention entails two phases. T2CR Phase 1 (Assess and Plan) is a program that occurs during or shortly after hospital discharge that includes completion of a comprehensive risk assessment, development of strategies to address identified risks while restoring function through education regarding living a healthy lifestyle and familiarization and practice of exercise training techniques. T2CR Phase 2 (Implementation and Support) entails a HBCR program that is based on the Promising Practices HBCR but further enriched by insights and strategies developed in T2CR Phase 1 and which also incorporates techniques that maximize the effectiveness and efficiency of exercise training.
Participants will receive usual care following an acute heart event that is recommended by their providers, which may include Promising Practices Home-Based Cardiac Rehabilitation (aka Usual HBCR) at both sites or site-based CR at VAPHS.
Locations(2)
View Full Details on ClinicalTrials.gov
For the most up-to-date information, visit the official listing.
NCT06244199