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

心血管疾病(CVD)在迅速增长的老年人口中是地方病。此外，年龄较大的 患有心血管疾病的成年人特别容易复发心血管事件以及与之相关的老年病 易受功能衰退、虚弱、虚弱和残疾的影响。心脏康复是一种 多维计划，促进CVD患者的医疗和功能恢复。老年心脑血管疾病患者 受益于CR，但只有少数人参与，即使在这一小部分中，与年龄有关的问题也很常见 妨碍充分参与和参与。问题的一个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，多病、多药、虚弱、 身体和认知能力下降、摔倒、抑郁和自我效能低下)。为了解决这一显著的年龄差距-- 敏化护理，我们开发了老年心脏康复的改良应用(MACRO)。 宏是一种创新战略，它将CR从基于CVD的计划转变为 计划相对更集中于有心血管疾病的患者，即MACRO增强CR并增加其 通过更好地将CR与老年复杂CVD患者的需求联系起来，提高了疗效。在随机对照试验中 我们将展示MACRO在较年长的CR候选人中实现了更大的参与度，具有卓越的 功能收益、健康和质量效益。宏旨在集成到现有的SOC-CR中 具有额外基础设施和流程的计划，以满足老年CR患者的需求。的价值 宏扩展到已被接受的基于站点、基于家庭和其他版本的SOC-CR 横跨当代CR；虽然每种CR模式都有支持者和利益相关者，但所有 尽管如此，对于解决老年人独特需求的具体方法也有类似的遗漏。 关键的宏观戒律是：(1)改进过渡(即从医院到CR和从CR到持续 行为)；(2)通过个性化目标设置与 全面评估风险(心血管疾病、功能和心理社会)，以指导管理；(3)患者- 集中参与和咨询技术，以激励患者，促进全面参与，并实现 抑郁、低自我效能感和/或认知障碍时的行为改变；(4)专家主导的去中心化 开处方，尽量减少复合药物对疲劳、跌倒、认知障碍或过度风险的影响； (5)个性化营养，以缓解骨骼减少和虚弱，同时优化简历健康；(6)家庭评估 以便最好地在患者的家庭环境中进行体力活动和保持健康。我们建议研究宏观 与SOC-CR作为随机对照的多点试验。终端包括短期(3个月)和长期(12个月 月)差异：(1)功能/质量指标；(2)参与度、依从性和患者报告 满意度；(3)跌倒、用药负担、再入院和住院。我们还将澄清哪些 患者亚组从宏观中受益最多。

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.