Modified Application of Cardiac Rehabilitation (CR) for Older Adults (MACRO)

老年人心脏康复 (CR) 的改良应用 (MACRO)

• 批准号: 10413034
• 负责人: Daniel E. Forman
• 金额: $ 93.32万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10413034
• 关键词: Accelerometer; Activities of Daily Living; Address; Adherence; Age; Aging; Behavior; Cardiac rehabilitation; Cardiology; Cardiovascular Diseases; Cardiovascular system; Caring; Characteristics; Clinical; Cognition; Cognitive deficits; Communities; Complex; Counseling; Data; Disease Management; Effectiveness; Elderly; Event; Fatigue; Fostering; Goals; Health; Healthcare Systems; Home; Home environment; Hospitalization; Hospitals; Impaired cognition; Individual; Infrastructure; Life; Link; Medical; Mental Depression; Methods; Modeling; Monitor; Motivation; Older Population; Outcome; Participant; Patient Self-Report; Patients; Pharmaceutical Preparations; Physical Function; Physical Performance; Physical activity; Polypharmacy; Predisposition; Procedures; Process; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Recovery of Function; Recurrence; Reporting; Research Personnel; Risk; Risk Assessment; Safety; Self Efficacy; Site; System; Techniques; Testing; Therapeutic; age related; base; behavior change; cardiovascular disorder risk; design; disability; experience; falls; flexibility; follower of religion Jewish; frailty; functional decline; functional gain; healthy lifestyle; hospital readmission; human old age (65+); improved; innovation; multi-site trial; multiple chronic conditions; nutrition; patient oriented; patient subsets; preference; primary outcome; prognostic; programs; psychosocial; response; sarcopenia; satisfaction; shared decision making; standard of care; tool

Cardiovascular disease (CVD) is endemic in the rapidly expanding population of older adults. Moreover, older adults with CVD are at particular risk for recurrent cardiovascular events as well as interrelated geriatric vulnerabilities to functional decline, weakening, frailty, and disability. Cardiac rehabilitation (CR) is a multidimensional program that enhances medical and functional recovery of CVD patients. Older CVD patients benefit from CR, but only few participate, and even among this small subset, age-related problems commonly impede full participation and engagement. A key part of the problem is that standard of care CR (SOC-CR) lacks fundamental constructs to address complexities of old age (e.g., multimorbidity, polypharmacy, frailty, physical and cognitive decline, falls, depression, and low self-efficacy). To address this significant gap in age- sensitized care, we developed Modified Application of Cardiac Rehabilitation for Older Adults (MACRO). MACRO is an innovative strategy that transforms CR from a program that is based oriented to CVD into a program relatively more centered on the patients who have CVD, i.e., MACRO enhances CR and increases its efficacy by better linking CR to the needs of older complex patients with CVD. In a randomized controlled trial we will show that MACRO achieves greater participation among older candidates for CR, with superior functional gains, wellness and qualitative benefits. MACRO is devised to integrate into existing SOC-CR programs with additional infrastructure and processes to meet needs of older CR patients. The value of MACRO extends to site-based, home-based, and other versions of SOC-CR that have become accepted across the spectrum of contemporary CR; while each mode of CR has proponents and stakeholders, all nonetheless share the similar omission of specific methods to address the distinctive needs of older adults. Key MACRO precepts are: (1) Improved transitions (i.e., from hospital to CR and from CR to sustained behaviors); (2) Shared decision making informed by personalized goal setting in combination with comprehensive assessments of risk (CVD, functional, and psychosocial) to guide management; (3) Patient- centered engagement and counseling techniques to motivate patients, facilitate full participation, and achieve behavior change despite depression, low self-efficacy, and/or cognitive impairment; (4) Expert-led de- prescribing to minimize polypharmacy’s contribution to fatigue, falls, cognitive impairment, or excessive risks; (5) Personalized nutrition to mitigate sarcopenia and frailty while optimizing CV health; (6) Home assessments to best enable physical activity and wellness in a patient’s home environment. We propose to study MACRO vs. SOC-CR as a randomized controlled multisite trial. Endpoints include short (3 month) and long-term (12 month) differences in: (1) functional/qualitative metrics; (2) participation, adherence and patient-reported satisfaction; and (3) falls, medication burden, readmissions and hospitalization. We will also clarify which patient subgroups benefit the most from MACRO.

在迅速扩大的老年人人群中，心血管疾病（CVD）是内在的。而且，年龄较大 CVD的成年人特别有复发性心血管事件以及相互关联的老年病风险 功能下降，虚弱，脆弱和残疾的脆弱性。心脏康复（CR）是 多维计划，可增强CVD患者的医学和功能恢复。老年CVD患者 受益于CR，但只有很少的参与，甚至在这个小子集中，通常与年龄有关的问题 阻碍全面参与和参与。问题的关键部分是护理标准CR（SOC-CR） 缺乏解决老年复杂性的基本构造（例如，多发病，多剂，脆弱，脆弱， 身体和认知能力下降，跌倒，抑郁和低自我效能感）。解决这个年龄的显着差距 - 敏感的护理，我们开发了对老年人（宏）的心脏康复的改良应用。 宏是一种创新策略，将CR从基于CVD的程序转变为一个 程序相对较为集中于具有CVD的患者，即宏可增强CR并增加其 通过更好地将CR与老年复杂患者的CVD患者的需求联系起来，有效性。在随机对照试验中 我们将表明，宏观在较老的CR中获得了更大的参与， 功能收益，健康和定性利益。宏被设计成整合到现有的SOC-CR中 具有额外基础设施和过程的计划，以满足老年CR患者的需求。价值 宏扩展到已被接受的基于站点的，基于家庭和其他版本的SOC-CR 在当代CR的范围内；尽管CR的每种模式都有支持者和利益相关者，但所有人都 尽管如此，分享了类似的省略特定方法，以满足老年人的独特需求。 关键宏观戒律是：（1）改进过渡（即从医院到CR，从CR到持续 行为）； （2）共享通过个性化目标设定告知的共同决策 全面评估风险（CVD，功能和心理社会），以指导管理； （3）患者 - 集中参与和咨询技术激励患者，促进全面参与并实现 行为改变目的地抑郁，自我效能低和/或认知障碍； （4）专家领导的DE- 开处方以最大程度地减少多药对疲劳，跌倒，认知障碍或过多风险的贡献； （5）个性化营养，以减轻肌肉减少症和脆弱性，同时优化简历健康； （6）房屋评估 最好在患者的家庭环境中实现体育锻炼和健康。我们建议研究宏 与SOC-CR作为随机控制的多站点试验。终点包括短期（3个月）和长期（12 月份）的差异：（1）功能/定性指标； （2）参与，依从性和患者报告 满意; （3）瀑布，药物伯恩，再入院和住院。我们还将澄清哪个 患者亚组受益最大。

项目成果

Cardiac rehabilitation for older adults: current evidence and future potential.

• DOI: 10.1080/14779072.2022.2035722
• 发表时间: 2022-01
• 期刊: Expert review of cardiovascular therapy
• 影响因子: 2
• 作者: Alfaraidhy MA;Regan C;Forman DE
• 通讯作者: Forman DE