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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

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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.
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