Modification and Pilot Testing of The Capacity cOaching And exerCise after Hospitalization for Heart Failure (COACH-HF) Intervention

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Research: The current standard of care for physical rehabilitation of Veterans hospitalized for heart failure (HF) is inadequate for 3 reasons: 1) When prescribed, Veterans may fail to engage in physical rehabilitation due to feeling overwhelmed by their overall high treatment workload, 2) Home physical therapy is often under- dosed and therefore fails to achieve clinical impact, and 3) Cardiac rehabilitation (CR) is rarely prescribed. When it is utilized, its focus on moderate intensity aerobic exercise is inappropriate for severely debilitated Veterans hospitalized for HF. I am the Principal Investigator of an NIA-funded pilot study (R03AG064371) (BAMS-HF [Balance, Aerobic capacity, Mobility and Strength in HF] study), which provides older Veterans recently hospitalized for HF with a novel, rigorous 1:1 physical therapist-led home-based rehabilitation intervention that is designed to address #2 and #3 above. Although Veterans who complete the study are enthusiastic about it, they do desire contact with other BAMS-HF Veterans and [report low motivation as a significant barrier to participation.] These insights and challenges from the BAMS-HF study led to the current proposal of the Capacity cOaching And exerCise after Hospitalization for Heart Failure (COACH-HF) intervention. Based on the preliminary results of the BAMS-HF pilot study and existing literature, COACH-HF will take a 2-pronged approach to physical rehabilitation in Veterans recently hospitalized for HF: 1) Capacity Coaching from a Peer Support Specialist (a Veteran with HF), and 2) Physical therapist-led rigorous, in-home strength, balance and mobility exercise protocol that will occur 3 days/week for a maximum of 12 weeks, and monthly group exercise sessions with the physical therapist and other COACH-HF Veterans until 6 months. [Modification of the proposed COACH-HF intervention] and pilot testing will occur over the following 2 Aims: [Aim 1: Garner stakeholder feedback on the structure and delivery of the COACH-HF intervention using [12] focus groups (FGs) among 3 stakeholder categories: Veterans recently hospitalized for HF, Veterans’ caregivers, and healthcare providers. Differing perspectives from the FGs will be addressed with a small decision-making group of investigators and stakeholders. Using nominal group technique (NGT), the decision- making group will brainstorm and rank ideas for addressing key areas of disagreement. The intervention design will be modified by the PI based on the FG and NGT results. All FGs participants will be invited to give feedback on the final intervention design prior to moving forward to pilot testing (i.e. member-checking).] [Aim 2: Determine whether Capacity Coaching increases adherence to the rehabilitation intervention by randomizing 25 Veterans ≥ 55 years recently hospitalized for HF 1:1 to Capacity Coaching + Rehabilitation intervention (CC+Rehab) vs. Rehabilitation only (Rehab Only). Assess the feasibility and acceptability of rehabilitation intervention (both arms) and Capacity Coaching (CC+Rehab arm).] Candidate: I am an advanced HF trained cardiologist with an interest in physical rehabilitation for Veterans hospitalized for HF. I am co-director of the clinical CR and HF programs at the Rocky Mountain Regional (RMR) VAMC. My career goal is to become an independent VA rehabilitation researcher specializing in physical rehabilitation of Veterans hospitalized for HF. This award will help me develop the skills in qualitative research, stakeholder engagement and clinical trial design for behavioral interventions that are necessary to achieve my career goals. The next step is to write a Merit Review application that proposes testing the efficacy of the COACH-HF intervention. Environment: This research will be conducted at the Rocky Mountain Regional VA Medical Center (RMR VAMC). The RMR VAMC is a tertiary care center that is affiliated with the University of Colorado Anschutz Medical Campus. The proposed study will leverage the existing resources and culture of supporting clinical research within the RMR VAMC, Cariology Division and the Seattle-Denver Center of Innovation.