The vast majority of cardiac rehabilitation eligible individuals do not participate in center based cardiac rehabilitation (CBCR). While steps to encourage participation in CBCR are important, many individuals will still not participate for a variety of reasons. This randomized controlled trial is evaluating a home-based cardiac rehabilitation (HBCR) intervention delivered using a custom app and digital tools in patients undergoing transcatheter heart valve interventions (THVIs). After a brief roll-in period, participants not intending to participate in CBCR are randomized to one of three groups: (1) control, (2) HBCR mobile health intervention with hands-off delivery, and (3) HBCR mobile health intervention with interactive delivery. Participants in the intervention groups (hands-off/interactive delivery) will also be randomized to continue the intervention for 12 weeks or 24 weeks. The intervention targets key health behaviors and includes traditional cardiac rehabilitation components. The study will assess the effect of the intervention on clinical events, physical activity, quality of life, and other outcomes. Those who intend to participate in CBCR will be followed in a registry.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
375
Home-based cardiac rehabilitation intervention facilitated by a custom app to deliver education, counseling on healthy living and modification of risk factors, mindfulness, and physical activity guidance.
Home-based cardiac rehabilitation intervention facilitated by a custom app to deliver education, counseling on healthy living and modification of risk factors, mindfulness, and physical activity guidance. Additionally, there are periodic video calls with an exercise physiologist.
Vanderbilt University Medical Center
Nashville, Tennessee, United States
RECRUITINGProbability of the hierarchical clinical event composite
The hierarchical clinical event composite includes (in order of hierarchy): (1) all-cause death; (2) all-cause hospitalization; and (3) skilled nursing facility visits. To examine whether the intervention improves mortality, hospitalization, and SNF rates after THVIs, we will conduct Bayesian Markov longitudinal proportional odds model on weekly outcome measures. The pooled active treatment vs. control group comparison (primary comparison for the trial) will be estimated by contrasting the average of posterior probability that Y≥y of the two active treatment groups (hands-off HBCR and interactive HBCR) to the control group.
Time frame: Over the entire available follow-up period for randomized participants (minimum of 6 months, maximum approximately 24-30 months).
Average daily total activity counts
Daily total activity counts are determined by a triaxial actigraphy device.
Time frame: The actigraphy device will be worn for approximately one week and, using data from days when the device was worn >10 hours, the average daily total activity counts determined. The primary comparison will be at 12 weeks after randomization.
Average daily total activity counts
Daily total activity counts are determined by a triaxial actigraphy device.
Time frame: The actigraphy device will be worn for approximately one week and, using data from days when the device was worn >10 hours, the average daily total activity counts determined. The secondary comparisons will be at 24 and 52 weeks after randomization.
Average daily active minutes
Daily active minutes are determined by a triaxial actigraphy device.
Time frame: The actigraphy device will be worn for approximately one week and, using data from days when the device was worn >10 hours, the average daily active minutes determined. The comparisons will be at 12, 24 and 52 weeks after randomization.
Average daily steps
Daily steps are determined by a triaxial actigraphy device.
Time frame: The actigraphy device will be worn for approximately one week and, using data from days when the device was worn >10 hours, the average daily steps determined. The comparisons will be at 12, 24 and 52 weeks after randomization.
Average daily energy expenditure
Daily energy expenditure is determined by a triaxial actigraphy device.
Time frame: The actigraphy device will be worn for approximately one week and, using data from days when the device was worn >10 hours, the average daily energy expenditure determined. The comparisons will be at 12, 24 and 52 weeks after randomization.
Average daily moderate to vigorous active minutes
Daily moderate to vigorous active minutes are determined by a triaxial actigraphy device.
Time frame: The actigraphy device will be worn for approximately one week and, using data from days when the device was worn >10 hours, the average daily moderate to vigorous active mins determined. The comparisons will be at 12, 24 and 52 weeks after randomization.
6 minute walk distance
The distance walked in 6 minutes.
Time frame: The comparisons will be at 12, 24 and 52 weeks after randomization.
Chair sit to stand time
The time taken to complete 5 chair rises.
Time frame: The comparisons will be at 12, 24 and 52 weeks after randomization.
5 meter gait speed
The speed of walking 5 meters (meters/second).
Time frame: The comparisons will be at 12, 24 and 52 weeks after randomization.
All-cause hospitalizations
Hospitalizations for any reason
Time frame: Over the entire available follow-up period for randomized participants (minimum of 6 months, maximum approximately 24-30 months).
All-cause death
Death for any cause
Time frame: Over the entire available follow-up period for randomized participants (minimum of 6 months, maximum approximately 24-30 months).
Heart-failure specific health status assessed by the KCCQ
Assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ); (score range 0-100, higher is better health status)
Time frame: The comparisons will be at 12, 24 and 52 weeks after randomization.
Physical health status assessed by the PROMIS 10
Global physical health score from the PROMIS 10 Global Health Short Form questionnaire (raw score range 4-20 with corresponding T score and SE, higher is better)
Time frame: The comparisons will be at 12, 24 and 52 weeks after randomization.
Mental health status assessed by the PROMIS 10
Global mental health score from the PROMIS 10 Global Health Short Form questionnaire (raw score range 4-20 with corresponding T score and SE, higher is better)
Time frame: The comparisons will be at 12, 24 and 52 weeks after randomization.
Mood disturbance assessed by PHQ9
Patient health questionnaire 9 (PHQ9); (score range 1-27, higher score worse)
Time frame: The comparisons will be at 12, 24 and 52 weeks after randomization.
Patient goals progress score
A patient goals progress score (-3 to +3) will be determined for 5 domains and the scores combined for a global score from -15 to +15.
Time frame: The comparisons will be at 12, 24 and 52 weeks after randomization.
Basic mobility by AM-PAC
Basic mobility will be assessed with the Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility Outpatient Short Form (Low Function); (raw score range 0-39 with corresponding T-score and SE, higher score is better)
Time frame: The comparisons will be at 12, 24 and 52 weeks after randomization.
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