Transition to Cardiac Rehabilitation (T2CR) to Address Barriers of Multimorbidity and Frailty

Description

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.

Conditions

Cardiovascular Diseases, Cardiac Rehabilitation, Transition of Care

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Study Overview

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Study Details

Study overview

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.

Transition to Cardiac Rehabilitation (T2CR) to Address Barriers of Multimorbidity and Frailty

Transition to Cardiac Rehabilitation (T2CR) to Address Barriers of Multimorbidity and Frailty

Condition
Cardiovascular Diseases
Intervention / Treatment

-

Contacts and Locations

Boston

VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA, Boston, Massachusetts, United States, 02130-4817

Pittsburgh

VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA, Pittsburgh, Pennsylvania, United States, 15240

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

For general information about clinical research, read Learn About Studies.

Eligibility Criteria

  • * 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
  • * 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

Ages Eligible for Study

18 Years to

Sexes Eligible for Study

ALL

Accepts Healthy Volunteers

No

Collaborators and Investigators

VA Office of Research and Development,

Daniel E Forman, MD, PRINCIPAL_INVESTIGATOR, VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA

Study Record Dates

2027-08-31