Evaluation of a mHealth Cardiac Rehabilitation Intervention in Older Veterans

项目摘要/摘要 心血管疾病(CVD)是导致死亡的主要原因，也是 成年人≥65岁。心脏康复(CR)是一种被证明可以减少死亡的二级预防策略 和复发的心血管事件，以及改善生理和心理功能。退伍军人构成 一个独特的患者群体，具有复杂的、升高的心血管风险特征，可以显著受益于CR。 人们经常提到的退伍军人参与传统的、以中心为基础的CR计划的障碍植根于社会 以及健康差距的经济驱动因素，如到CR中心的地理距离、交通 限制和患者优先。技术增强CR(TECR)，一种改编的基于家庭的CR计划 随着技术的补充(例如，视频访问、远程心脏监测、健身跟踪器)已经 被宣传为潜在的解决方案。TECR在吸引VA患者方面取得了初步成功，但出现了新的 老年人面临的挑战。然而，必须考虑的与老龄化有关的挑战包括身体和 认知限制，减少对行为改变的程序性社会支持，以及焦虑和沮丧 学习和运用新技术。对老年退伍军人TECR干预措施的评估是 有限的，新冠肺炎的运营限制和安全保护强调了 了解针对弱势群体的替代CR策略。该项目将建立在现有的 在退伍军人人群中评估CR的务实试验，并采用混合方法序贯设计 检查参与TECR的交叉决定因素。使用一个多生态、理论驱动的框架， 该项目寻求实现三个目标。第一个目标将确定上下文、人际和个人级别 使用来自父母研究的次要数据预测老年退伍军人参加TECR计划的人数。 同样，第二个目标涉及二次分析，以确定积极参与的多层面关联 在参加TECR的退伍军人中。在前两个目标结果的基础上，分两个阶段进行定性研究 将进行a)检查TECR感知的易用性、感知的有用性和对 在选择或拒绝参加TECR的合格退伍军人中进行TECR；以及b)检查障碍和促进者 参加TECR的老年人的参与度。建议的研究是及时和直接与 国家老龄问题研究所的战略方向。通过使用基于理论的框架来评估TECR 参与，这项研究将确定增加注册和遵守 有效的心血管行为改变干预。了解这些因素的机制是至关重要的。 用于增加老年退伍军人的CR摄取率和减少健康差距。

PROJECT SUMMARY/ABSTRACT Cardiovascular disease (CVD) is the leading cause of death and a substantial source of morbidity for adults ≥ 65 years old. Cardiac rehabilitation (CR) is a secondary prevention strategy proven to reduce death and recurrent CVD events, as well as improve physiological and psychological functioning. Veterans constitute a unique patient population with complex, elevated CVD risk profiles that could significantly benefit from CR. Frequently cited barriers for veteran participation in traditional, center-based CR programs are rooted in social and economic drivers of health disparities, such as geographic distance to CR centers, transportation limitations, and patient priorization. Technology-enhanced CR (TECR), an adapted home-based CR program with technological supplements (e.g., video-enabled visits, remote heart monitoring, fitness trackers) has been promoted as a potential solution. TECR has seen early success with engaging VA patients but presents new challenges for older adults. However, aging-related challenges that must be considered include physical and cognitive limitations, reduced programmatic social support for behavior change, and anxiety and frustration with learning and operating new technologies. Evaluations of TECR interventions among older veterans is limited, and COVID-19 operational restrictions and safety protections underscore the urgency for understanding alternative CR strategies for vulnerable populations. This project will build on an existing pragmatic trial evaluating CR in a veteran population and employ a mixed-methods sequential design to examine intersectional determinants of TECR participation. Using a multi-ecological, theory-driven framework, the project seeks to achieve three aims. The first aim will identify contextual, interpersonal, and individual-level predictors of enrollment for older veterans in a TECR program using secondary data from the parent study. Similarly, the second aim involves a secondary analysis to identify multilevel correlates of active engagement among veterans who enroll in TECR. Building on the results of the first two aims, a two-stage qualitative study will be conducted to a) examine TECR perceived ease of use, perceived usefulness, and attitudes towards TECR among eligible veterans who select or decline TECR enrollment; and b) examine barriers and facilitators of engagement for older adults enrolled in TECR. The proposed research is timely and directly aligns with the strategic directions for the National Institute on Aging. By using a theory-based framework to evaluate TECR participation, this study will identify strengths and opportunities for increasing enrollment and adherence to an effective CVD behavior change intervention. Understanding how these factors work mechanistically is crucial for increasing CR uptake and reducing health disparities for older veterans.