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 在医疗保险受益人中，心力衰竭(HF)每年导致100多万人住院，是一种 老年人不良后果的主要危险因素，包括与医院相关的残疾、再住院 和死亡率，以及功能状态的下降。因心力衰竭住院的患者不仅要从心力衰竭中恢复 恶化，本身就会导致骨骼肌的不利变化，但也必须从 解除条件和急性石棺减少是由于住院而发生的，而不考虑 病因学。目前，很少有针对住院老年人独特需求的康复方案 用于HF。心脏康复(CR)是一项综合的、为期12周的锻炼和生活方式改变计划 通常在医疗机构的监督下进行管理。然而，许多较年长的人无法访问CR 成人因缺乏经济和社会资源而因心力衰竭住院。基于家庭的CR(HBCR)也是 许多因心力衰竭住院的老年人无法接触到，因为摔倒的风险太高，无法执行 无人监督的运动。在有能力参加CR的患者中，医疗保险和医疗补助中心 服务只对6周内未住院的患者报销CR。最脆弱的人 心力衰竭患者的再住院时间是出院后30天，留下了显著的 康复差距。力量、有氧健身和平衡(SAB-HF计划)旨在恢复 老年人使用一种新的、基于中到高强度间歇运动计划的心衰住院治疗。这个 SAB-HF计划在大多数住院和急性后护理中提供比通常更严格的康复护理 设置，旨在最大限度地遵守与LOWER关联的基于间隔的协议 感觉到的劳累，并由训练有素的理疗师在家中实施这项计划。最后， SAB-HF计划是为患者过渡到HBCR计划的明确目标而设计的。这笔赠款 建议对SAB-HF计划与常规护理进行试点随机试验。这项初步研究的目标是 在老年人(65岁)中测试SAB-HF计划的可行性、可接受性和初步效果 因心力衰竭住院治疗。如果SAB-HF计划是可行的，那么这些数据将为更大的 SAB-HF联合HBCR与单纯HBCR在老年人中的疗效比较试验 因心力衰竭住院治疗。最终，这项研究可能会导致创建一个全面的、以患者为中心的、 以家庭为基础的康复干预，旨在防止老年人的残疾和依赖程度恶化 成人因心力衰竭住院。

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.