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: 10165449
• 负责人: Daniel E. Forman
• 金额: $ 96.44万
• 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 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10165449
• 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.

心血管疾病（CVD）在快速增长的老年人口中流行。 患有心血管疾病的成年人特别容易发生心血管事件以及相关的老年病 功能衰退、虚弱、虚弱和残疾是心脏康复 (CR) 的一个弱点。 促进老年 CVD 患者的医疗和功能恢复的多维计划。 从 CR 中受益，但只有少数人参与，即使在这一小部分人中，与年龄相关的问题也很常见 问题的一个关键部分是护理标准 CR (SOC-CR)。 缺乏解决老年复杂性的基本结构（例如，多病、多药治疗、虚弱、 身体和认知能力下降、跌倒、抑郁和自我效能感低下）。 敏化护理，我们开发了老年人心脏康复改良应用（MACRO）。 MACRO是一项创新战略，它将CR从一个以CVD为基础的计划转变为一个以CVD为基础的计划。 计划相对更集中于患有 CVD 的患者，即 MACRO 增强 CR 并增加其 在一项随机对照试验中，通过将 CR 与老年复杂 CVD 患者的需求更好地联系起来，取得了疗效。 我们将证明 MACRO 在年龄较大的 CR 候选人中实现了更大的参与，并且具有优越性 MACRO 旨在整合到现有的 SOC-CR 中。 具有额外基础设施和流程的计划，以满足老年 CR 患者的需求。 MACRO 扩展到基于站点、基于家庭以及已被接受的 SOC-CR 的其他版本 跨越当代 CR 的各个领域；虽然每种 CR 模式都有支持者和利益相关者，但 然而，同样缺乏满足老年人独特需求的具体方法。 关键的宏观规则是：(1) 改进过渡（即从医院到 CR 以及从 CR 到持续 (2) 通过个性化目标设定结合信息共享决策 全面评估风险（CVD、功能和心理）以指导管理； 以集中的参与和咨询技术来激励患者、促进充分参与并实现 尽管存在抑郁、自我效能感低和/或认知障碍，但行为发生改变；(4) 专家主导的去- 开处方以尽量减少复方用药对疲劳、跌倒、认知障碍或过度风险的影响； (5) 个性化营养，以减轻肌肉减少症和虚弱，同时优化心血管健康；(6) 家庭评估； 为了最好地促进患者家庭环境中的身体活动和健康，我们建议研究宏观。 与 SOC-CR 作为随机对照多中心试验相比，终点包括短期（3 个月）和长期（12 个月）。 月）差异：（1）功能/定性指标；（2）参与、依从性和患者报告 (3) 跌倒、药物负担、再入院和住院治疗。 患者亚组从 MACRO 中受益最多。