Modified Application of Cardiac Rehabilitation (CR) for Older Adults (MACRO)

心血管疾病（CVD）是迅速扩大的老年人人群中的地方病。此外， 成年心血管疾病患者特别容易发生复发性心血管事件， 易受功能衰退、衰弱、虚弱和残疾的影响。心脏康复（CR）是一种 一个多维的计划，提高心血管疾病患者的医疗和功能恢复。老年CVD患者 受益于CR，但只有少数参与，即使在这个小子集中，与年龄有关的问题通常 阻碍充分参与和参与。问题的关键部分是护理标准CR（SOC-CR） 缺乏解决老年复杂性的基本结构（例如，多药，多药，虚弱， 身体和认知能力下降、福尔斯、抑郁和低自我效能）。为了弥补年龄上的巨大差距- 为了提高患者的敏感性，我们开发了老年人心脏康复的改良应用（MACRO）。 MACRO是一个创新的战略，将CR从一个基于CVD的计划转变为一个基于 计划相对更集中于患有CVD的患者，即，MACRO增强了CR并增加了其 通过更好地将CR与患有CVD的老年复杂患者的需求联系起来来提高疗效。在一项随机对照试验中 我们将表明，MACRO在年龄较大的CR候选人中实现了更大的参与，具有上级 功能收益、健康和质量收益。MACRO旨在集成到现有的SOC-CR中 计划提供额外的基础设施和流程，以满足老年CR患者的需求。的价值 MACRO扩展到基于站点的、基于家庭的以及其他已被接受的SOC-CR版本 在当代CR的范围内;虽然每种CR模式都有支持者和利益相关者，但所有 然而，他们也同样忽略了解决老年人特殊需要的具体方法。 关键的宏观规则是：（1）改善过渡（即，从住院到CR和从CR到持续 行为）;（2）通过个性化目标设定以及 全面评估风险（CVD、功能和心理社会），以指导管理;（3）患者- 以参与和咨询技术为中心，激励患者、促进充分参与并实现 行为改变，尽管抑郁症，自我效能低，和/或认知障碍;（4）专家领导的去， 处方以尽量减少多种药物对疲劳、福尔斯、认知障碍或过度风险的影响; (5)个性化营养，以减轻肌肉减少症和虚弱，同时优化CV健康;（6）家庭评估 以在患者的家庭环境中最好地实现身体活动和健康。我们建议研究宏观 vs. SOC-CR是一项随机对照多中心试验。终点包括短期（3个月）和长期（12 （1）功能/定性指标;（2）参与、依从性和患者报告 满意度;（3）福尔斯、药物负担、再入院和住院。我们还将阐明 患者亚组从MACRO获益最多。

Cardiovascular disease (CVD) is endemic in the rapidly expanding population of older adults. Moreover, older adults with CVD are at particular risk for recurrent cardiovascular events as well as interrelated geriatric vulnerabilities to functional decline, weakening, frailty, and disability. Cardiac rehabilitation (CR) is a multidimensional program that enhances medical and functional recovery of CVD patients. Older CVD patients benefit from CR, but only few participate, and even among this small subset, age-related problems commonly impede full participation and engagement. A key part of the problem is that standard of care CR (SOC-CR) lacks fundamental constructs to address complexities of old age (e.g., multimorbidity, polypharmacy, frailty, physical and cognitive decline, falls, depression, and low self-efficacy). To address this significant gap in age- sensitized care, we developed Modified Application of Cardiac Rehabilitation for Older Adults (MACRO). MACRO is an innovative strategy that transforms CR from a program that is based oriented to CVD into a program relatively more centered on the patients who have CVD, i.e., MACRO enhances CR and increases its efficacy by better linking CR to the needs of older complex patients with CVD. In a randomized controlled trial we will show that MACRO achieves greater participation among older candidates for CR, with superior functional gains, wellness and qualitative benefits. MACRO is devised to integrate into existing SOC-CR programs with additional infrastructure and processes to meet needs of older CR patients. The value of MACRO extends to site-based, home-based, and other versions of SOC-CR that have become accepted across the spectrum of contemporary CR; while each mode of CR has proponents and stakeholders, all nonetheless share the similar omission of specific methods to address the distinctive needs of older adults. Key MACRO precepts are: (1) Improved transitions (i.e., from hospital to CR and from CR to sustained behaviors); (2) Shared decision making informed by personalized goal setting in combination with comprehensive assessments of risk (CVD, functional, and psychosocial) to guide management; (3) Patient- centered engagement and counseling techniques to motivate patients, facilitate full participation, and achieve behavior change despite depression, low self-efficacy, and/or cognitive impairment; (4) Expert-led de- prescribing to minimize polypharmacy’s contribution to fatigue, falls, cognitive impairment, or excessive risks; (5) Personalized nutrition to mitigate sarcopenia and frailty while optimizing CV health; (6) Home assessments to best enable physical activity and wellness in a patient’s home environment. We propose to study MACRO vs. SOC-CR as a randomized controlled multisite trial. Endpoints include short (3 month) and long-term (12 month) differences in: (1) functional/qualitative metrics; (2) participation, adherence and patient-reported satisfaction; and (3) falls, medication burden, readmissions and hospitalization. We will also clarify which patient subgroups benefit the most from MACRO.