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

中高强度家庭康复计划作为因心力衰竭住院的老年人心脏康复桥梁的试点研究

• 批准号: 10005109
• 负责人: Kelsey M Flint
• 金额: $ 9.06万
• 依托单位: DENVER RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10005109
• 关键词: Acute; Address; Adherence; Adopted; Adult; Aerobic; Aerobic Exercise; Age; Cardiac Surgery procedures; Cardiac rehabilitation; Caring; Data; Dependence; Diagnosis; EFRAC; Elderly; Enrollment; Equilibrium; Etiology; Exercise; Exertion; Goals; Grant; Health care facility; Heart failure; Home environment; Hospitalization; Hospitals; Hour; Inpatients; Institutionalization; Intervention; Interview; Lead; Life Style; Life Style Modification; Measures; Medical center; Medicare; Mortality Decline; Myocardial Ischemia; Outcome; Outcome Measure; Participant; Patients; Physical Performance; Physical activity; Pilot Projects; Policies; Population; Protocols documentation; Qualifying; Quality of life; Rehabilitation therapy; Research; Resources; Risk; Risk Factors; Site; Skeletal Muscle; Structure; Supervision; Testing; Time; Training; Transportation; United Kingdom; United States Centers for Medicare and Medicaid Services; Veterans; acute care; adverse outcome; arm; base; beneficiary; care systems; deconditioning; design; disability; efficacy trial; exercise program; experience; fall risk; falls; functional decline; hospital readmission; improved; innovation; intervention effect; lifestyle intervention; mortality; muscle form; novel; patient oriented; physical therapist; preservation; prevent; programs; randomized trial; rehabilitative care; sarcopenia; sedentary; skills; social; treatment as usual; trial comparing; usual care arm

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.

摘要/项目摘要 心力衰竭（HF）在医疗保险受益人中每年占100万以上住院 老年人的广告结果的主要风险因素，包括医院相关的残疾，重新住院 和死亡率，功能状况下降。 HF住院的患者不仅必须从HF中恢复过来 加重，这本身会导致骨骼肌肉的不良变化，但也必须从 由于住院而发生的，因此发生的肌肉减少症和急性肌肉减少症 病因。目前，几乎没有针对老年人住院的独特需求的康复计划 对于HF。心脏康复（CR）是一项全面的12周练习和生活方式修改计划 通常在医疗机构的监督下进行管理。但是，CR对于许多年龄较大的 由于缺乏财务和社会资源，成人住院的HF住院。基于家庭的CR（HBCR）也是 许多因HF住院的老年人无法访问，因为跌倒的风险太高，无法执行 无监督运动。在能够参加CR的患者中，医疗保险和医疗补助中心 服务仅在6周没有住院的患者中为CR报销。最脆弱的 HF患者的重新住院时间是出院后的前30天，留下了明显的 康复差距。强度，有氧健身和平衡（SAB-HF计划）旨在恢复 老年人使用一种基于中等强度的运动间隔运动计划为HF住院。这 SAB-HF计划比在大多数住院和急性后护理中提供的往常更严格 设置，旨在通过与较低的基于间隔的协议最大化依从性 感知的努力，并通过训练有素的物理治疗师在家中管理该计划。最后， SAB-HF计划是为将患者转换为HBCR计划的明确目标而设计的。这笔赠款 提案对SAB-HF计划的试验随机试验与通常的护理。这项试验研究的目的是 测试SAB-HF计划在老年人（65岁）成年人中的可行性，可接受性和初步效果 住院HF。如果SAB-HF程序是可行的，那么这些数据将为较大的基础奠定基础 比较SAB-HF计划的效率试验，其次是HBCR与HBCR的老年人相比 住院HF。最终，这项研究可能导致创建一个全面的，以患者为中心的 旨在防止老年人的残疾和依赖性的家庭康复干预措施 成人住院的HF。