Document text
Principal Investigator: Daniel E. Forman
Organization: VETERANS HEALTH ADMINISTRATION
Fiscal Year: 2024
Funding agency: Veterans Affairs
Cardiac rehabilitation (CR) is an evidence-based secondary prevention program for patients with
cardiovascular disease (CVD) that aims to stabilize patients clinically and to restore physical function and
health after a CVD event. It is well-suited to the needs of the aging Veterans Health Administration’s (VHA)
aging population which is prone to CVD in a context of comorbidity, frailty, and associated functional decline.
Unfortunately, few eligible Veterans participate. Logistic challenges are a key barrier as few VHA site-based
CR programs are available. The Promising Practice home-based CR (HBCR) is a VHA initiative that was
designed to improve CR participation using a novel home-based approach. While HBCR has been
demonstrated to be effective for Veterans who attend, only few participate. Many Veterans eligible for HBCR
remain encumbered by comorbidity and frailty, and often lack confidence and/or perceived capacity for home-
based formats of care. The Transition to CR (T2CR) intervention is a 2-phase program that aims to improve
the process of HBCR and to thereby better respond to Veterans’ needs. T2CR Phase 1 is a ~2 day face-to-
face program between the initial CVD hospitalization and home that includes comprehensive assessment of
holistic risks (CVD and non-CVD), functional limitations, and psychosocial circumstances. Individualized
pragmatic plans are formulated to ensure HBCR is feasible, safe, and practical despite aggregate complexity.
Goal setting, adherence reinforcements, and education are integrated; exercise practice is emphasized; and
consultations for comorbid issues and telemedicine video facilitation are arranged. T2CR Phase 2 is HBCR
that is enriched by the orientation, practice, consultations, supports, and goal setting that were initiated in
T2CR Phase 1, as well as innovative exercise training techniques for patients who are frail and/or functionally
impaired. T2CR is aligned with the already existing Coordinated Transitional Care (C-TraC) Program. C-TraC
nurse practitioners currently hone medication management, medical follow-up, and education as hospitalized
Veterans transition to home, but do little to guide recovery of physical function. By facilitating referral to the
T2CR intervention, C-TraC care will be enhanced. Using a hybrid efficacy-implementation (type 1) design, we
propose a randomized controlled trial to study T2CR versus usual HBCR in the VA Pittsburgh and Boston
Healthcare Systems. Quantitative endpoints will include functional gains (assessed using the Activity Measure
for Post-Acute Care [AM-PAC CAT]) over 365 days as well as a 5-Times Sit-To-Stand performance measure.
The number of CR sessions attended, rehospitalizations, and Healthy Days at Home will be assessed.
Patients’ perceptions of feasibility and acceptability of T2CR will be also be evaluated. Providers’ perceptions
of will be evaluated as well; the Consolidated Framework for Implementation Research (CFIR) framework will
be used to structure their insights. Patient and provider feedback will be applied to refine implementation
strategies with the goal to ultimately extend T2CR throughout the entire ORH Promising Practices network.
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Controlled Trials><Recovery><Recovery of Function><Recurrence><Recurrent><Reinforcement><Reporting><Risk><Rural Health><Safety><Secondary Prevention><Self Efficacy><Site><Social Psychology><Standardization><Structure><Survival Rate><Survivors><Telemedicine><Tissue Growth><Training Technics><Training Technique><United States Department of Veterans Affairs><United States Veterans Administration><Veterans><Veterans Administration><Veterans Affairs><Veterans Health Administration><Veterans Health Affairs><Work><acceptability and feasibility><access to health services><access to services><access to treatment><accessibility to health services><active followup><acute care><aged group><aged groups><aged individual><aged individuals><aged people><aged person><aged persons><aged population><aged populations><aging population><availability of services><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><cardiac rehab><cardiovascular disorder><care access><care as usual><co-morbid><co-morbidity><comorbidity><consultation><coronavirus disease 2019><coronavirus disease 2019 risk><coronavirus disease 2019 risk factor><coronavirus disease-19><coronavirus infectious disease-19><cost><daily living function><daily living functionality><decline in function><decline in functional status><design><designing><disability><effectiveness and implementation trial><effectiveness/implementation hybrid trial><effectiveness/implementation trial><evidence base><exercise training><experience><extended care><follow up><follow-up><followed up><followup><frailty><functional ability><functional capacity><functional decline><functional gain><functional recovery><functional status decline><geriatric medicine><health care><health care personnel><health care worker><health provider><health service access><health services availability><health workforce><healthcare personnel><heart rehabilitation><homes><hospital re-admission><hospital readmission><implementation 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implementation><synergism><treatment access><treatment as usual><treatment provider><usual care>