Pilot Study of a Moderate- to High-Intensity Home-based Rehabilitation Program as a Bridge to Cardiac Rehabilitation in Older Adults Hospitalized for Heart Failure

摘要/项目摘要 心力衰竭（HF）每年在医疗保险受益人中占超过100万例住院治疗，是一种严重的疾病。 老年人不良结局的主要风险因素，包括医院相关残疾、再住院 以及功能状态的下降。因HF住院的患者不仅必须从HF中恢复， 急性加重，其本身导致不利的骨骼肌变化，但也必须从急性加重中恢复。 由于住院而发生的失调和急性肌肉减少症， 病因学目前，很少有针对住院老年人独特需求的康复计划 对于HF。心脏康复（CR）是一项为期12周的综合性运动和生活方式调整计划 通常在健康护理机构的监督下施用。然而，CR对于许多老年人来说是不可访问的。 由于缺乏经济和社会资源，因HF住院的成年人。基于家庭的CR（HBCR）也是 许多因HF住院的老年人无法使用，因为跌倒风险太高，无法执行 无监督的锻炼在能够参与CR的患者中，医疗保险和医疗补助中心 服务仅对未住院6周的患者的CR进行报销。最脆弱的 HF患者的再住院时间是出院后的前30天， 康复差距。力量，有氧健身和平衡（SAB-HF计划）旨在恢复 老年人因HF住院，使用一种新的，中到高强度的间歇性运动计划。的 SAB-HF计划比大多数住院和急性期后护理中提供的常规康复护理更严格 设置，并旨在最大限度地遵守与较低的 感知的努力，并通过管理程序在家里由训练有素的物理治疗师。最后 SAB-HF计划旨在明确将患者过渡到HBCR计划的目标。这笔赠款 提出了一个试点随机试验的SAB-HF程序与常规护理。这项试验性研究的目的是 测试SAB-HF计划在老年人（> 65岁）中的可行性、可接受性和初步效果 因HF住院。如果SAB-HF计划是可行的，那么这些数据将为更大的 一项在老年人中比较SAB-HF计划后HBCR与单独HBCR的疗效试验 因HF住院。最终，这项研究可能会导致建立一个全面的，以病人为中心， 旨在防止老年人残疾和依赖性恶化的家庭康复干预 因HF住院的成人。

ABSTRACT/PROJECT SUMMARY Heart failure (HF) accounts for over 1 million hospitalizations annually among Medicare beneficiaries, and is a major risk factor for adverse outcomes in older adults, including hospital associated disability, rehospitalization and mortality, and decline in functional status. Patients hospitalized for HF must not only recover from a HF exacerbation, which in and of itself leads to adverse skeletal muscle changes, but must also recover from the deconditioning and acute sarcopenia that occurs as a consequence of being hospitalized irrespective of etiology. Currently, there are few rehabilitation programs aimed at the unique needs of older adults hospitalized for HF. Cardiac rehabilitation (CR) is a comprehensive, 12-week exercise and lifestyle modification program typically administered under supervision in a healthcare facility. However, CR is inaccessible to many older adults hospitalized for HF due to lack of financial and social resources. Home-based CR (HBCR) is also inaccessible to many older adults hospitalized for HF because risk of falling is too high to perform unsupervised exercise. Among patients capable of participating in CR, the Centers for Medicare and Medicaid Services only reimburse for CR in patients who have not been hospitalized for 6 weeks. The most vulnerable time for rehospitalization for patients with HF is the first 30 days after discharge, leaving a significant rehabilitation gap. The Strength, Aerobic fitness and Balance (SAB-HF Program) is designed to rehabilitate older adults hospitalized for HF using a novel, moderate-to-high intensity interval-based exercise program. The SAB-HF Program is more rigorous than usual rehabilitation care provided in most inpatient and post-acute care settings, and is designed to maximize adherence with an interval-based protocol associated with lower perceived exertion, and by administering the program in the home by a trained physical therapist. Finally, the SAB-HF Program is designed for the express goal of transitioning patients to a HBCR program. This grant proposes a pilot randomized trial of the SAB-HF Program versus usual care. The objective of this pilot study is to test the feasibility, acceptability and preliminary effect of the SAB-HF Program in older (65 years) adults hospitalized for HF. If the SAB-HF Program is feasible, then these data will lay the groundwork for a larger efficacy trial comparing the SAB-HF Program followed by HBCR vs. HBCR alone among older adults hospitalized for HF. Eventually, this research may lead to the creation of a comprehensive, patient-centered, home-based rehabilitation intervention aimed at preventing worsening disability and dependence among older adults hospitalized for HF.