Enabling Older Adults to 'LiveWell' with Advanced Heart Failure: Development of a Palliative Rehabilitation Model

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PROJECT SUMMARY/ABSTRACT Americans aged 65 years and older account for 70% of heart failure (HF)-related hospitalizations each year, and many in this population are burdened by multimorbidity, functional limitations, and high symptom burden. As HF becomes advanced (New York Heart Association Class III-IV) disease burden increases substantially, especially in the last 6 months of life when 80% of individuals are hospitalized at least once and many endorse significant distress related to functional decline and inability to participate in life roles and activities. Despite widespread recognition of the distinct benefits of physical rehabilitation and palliative care in improving symptoms and quality of life among individuals with HF, these services are separate in their approach and underutilized. To date, physical rehabilitation models have not been designed to simultaneously address the complex psychosocial and functional needs of older adults with advanced HF. To optimize quality of life in this vulnerable population, a novel rehabilitation strategy that holistically addresses biopsychosocial impairments is needed. My K23 proposal will address this need by developing and testing LiveWell-HF, a home-based physical therapy model supplemented with evidence-based, psychological strategies from early integrated palliative care to improve coping and acceptance among older adults after hospitalization for advanced HF. Specifically, I aim to 1) develop the preliminary LiveWell-HF model with provider and patient stakeholder input; 2) refine LiveWell-HF using an open pilot study design; and 3) evaluate the feasibility, acceptability, and fidelity of the refined LiveWell-HF model by conducting a pilot randomized controlled trial. Findings from these aims will inform a R01 efficacy trial as well as future work to determine the impact of LiveWell-HF on healthcare utilization and an extension of the model tailored for care partners. The aims of this proposal will be supported by my career development activities, which focus on 1) developing advanced clinical and research expertise in palliative care, 2) qualitative and mixed methods research to develop and refine evidence-based rehabilitation interventions, 3) clinical trials research, and 4) leadership development. My exemplary team of mentors and advisors will be led by Dr. Christine Ritchie, an internationally renowned geriatrician and palliative care physician with extensive experience conducting mixed methods research and clinical trials in patients with serious illness. The complementary expertise of my mentors and advisors, rich institutional environment at Massachusetts General Hospital and Harvard Medical School, and my training plan will enable me to successfully complete the training and research aims in this application. This K23 proposal will provide me with the skills and data needed to launch my career as an independent investigator and leader at the intersection of physical rehabilitation, palliative care, and geriatric cardiology. Ultimately this line of research can improve the lived experience of older adults with advanced HF and change the way physical rehabilitation strategies are designed to meet the needs of older adults with serious illness.