Cardiac Event, Cardiovascular Diseases, Telemedicine
Conditions
Brief summary
The proposed trial is a multiphase, multicenter, non-inferiority, hybrid type 1 effectiveness, randomized controlled trial to test an innovative virtual world-based cardiac rehabilitation (CR) program, "Destination Cardiac Rehab". The primary objectives of this study are to assess the efficacy and adherence of "Destination Cardiac Rehab" compared to traditional center-based CR.
Detailed description
The proposed virtual world-based cardiac rehabilitation (VWCR) program provides a novel home-based delivery method of a CR program to address several barriers to care associated with traditional center-based CR (CBCR). This 2-arm, randomized controlled trial (RCT) will rigorously assess adherence and efficacy of VWCR compared to CBCR in a 12-week (36-session) intervention that includes patient education, self-monitoring of physical activity and blood pressure, social support, and weekly telehealth visits with a CR nurse and exercise physiologist. Patients with a CR eligible cardiovascular event will be recruited from 6 geographically diverse CR centers across the United States. We hypothesize that the VWCR, known as "Destination Cardiac Rehab" will be non-inferior to CBCR as assessed by improvement in cardiovascular health and adherence to CR sessions.
Interventions
OTHERVirtual World-Based Cardiac Rehabilitation (VWCR)
12-week virtual world technology-based program via Second Life platform. Weekly virtual visits with nurse coach and exercise physiologist, weekly education sessions, and social support group discussions within the virtual world environment.
OTHERCenter-Based Cardiac Rehabilitation (CBCR)
Traditional 12-week in-person cardiac rehabilitation program; standard of care at participant's cardiac rehabilitation facility
Sponsors
Mayo Clinic
Johns Hopkins University
University of California, Irvine
University of Mississippi Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Indication for CR according to Centers for Medicare \& Medicaid Services (CMS) guidelines: Myocardial infarction within the preceding 12 months; Coronary artery bypass surgery; Current stable angina (chest pain); Heart valve repair or replacement; Percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting; Heart or heart-lung transplant; Stable chronic heart failure * Aged ≥18 years * Basic Internet navigation skills * Active email address
Exclusion criteria
* High risk patients according to the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) risk stratification (e.g., sudden cardiac arrest survivor) * Receiving continuous inotropic support * Presence of a mechanical circulatory support device * Decompensated heart failure * Symptomatic valvular heart disease * Uncontrolled angina * Presence of hemodynamically unstable dysrhythmias (e.g., ventricular tachycardia) given safety concern of unsupervised exercise20 * Pregnant (due to associated hormonal and weight changes) * Non-English-speaking * Visual/hearing impairment or mental disability that would preclude independent use of the VW platform
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of sessions attended by participants | Baseline through 12-week program | Optimal adherence defined as completion of 70% or more of weekly visits (in-person or virtual). Attendance measured by CR staff for control group, and by VWCR web administrators, Exercise Physiologists, and Nurse Coaches in the VWCR arm. |
| Life's Essential 8 component: Self-reported healthy diet | Baseline, 3 months, and 6 months post-randomization | Changes from baseline in healthy diet using the Mediterranean Eating Patterns for Americans (MEPA), a 16-item questionnaire evaluating accordance with a Mediterranean-like diet pattern |
| Life's Essential 8 component: Self-reported physical activity | Baseline, 3 months, and 6 months post-randomization | Changes from baseline in physical activity using the International Physical Activity Questionnaire (IPAQ), a 12-item questionnaire classifying physical activity as "low," "moderate," or "high" intensity physical activity (minutes/day) over the prior week |
| Life's Essential 8 component: Self-Reported smoking status | Baseline, 3 months, and 6 months post-randomization | Changes from baseline in smoking status using the National Health and Nutrition Examination Survey-Smoking-Cigarette Use Questionnaire (NHANES-SMQ), evaluating current and past smoking habits |
| Life's Essential 8 component: Sleep Quality | Baseline, 3 months, and 6 months post-randomization | Changes from baseline in sleep quality (number of hours of sleep nightly) using the Pittsburg Sleep Quality Index (PSQI). |
| Life's Essential 8 component: Body Mass Index (BMI) | Baseline, 3 months, and 6 months post-randomization | Changes from baseline in BMI as calculated with weight (kg) and height (m), reported as kg/m\^2 |
| Life's Essential 8 component: Cholesterol | Baseline, 3 months, and 6 months post-randomization | Changes from baseline in Non-HDL Cholesterol levels reported as mg/dL |
| Life's Essential 8 component: Blood Glucose | Baseline, 3 months, and 6 months post-randomization | Changes from baseline in Hemoglobin A1c (percent) and fasting blood glucose (mg/dL) |
| Life's Essential 8 component: Blood Pressure | Baseline, 3 months, and 6 months post-randomization | Changes from baseline in systolic and diastolic blood pressure measurements; average of three sitting readings in mmHg |
| Life's Essential 8 composite score: Cardiovascular health | Baseline, 3 months, and 6 months post-randomization | Changes from baseline in Life's Essential 8 score. Life's Essential 8 composite score is determined as a composite of all components by calculating an unweighted average score on a scale of 0 to 100 points. An overall cardiovascular health score (Life's Essential 8 score) will be considered high (80 to 100 points), moderate (50 to 79 points) or low for (0 to 49 points). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Diet Social Support | Baseline, 3 months, and 6 months post-randomization | Changes from baseline in diet social support using the Social Support for Eating Habits Survey scale that asks participants how much encouragement they received to eat healthier on a five-point scale from 1 (never) to 5 (very often). Higher scores indicate more social support for healthy eating. |
| MACE (Major Adverse Cardiovascular Events) 3 months post-randomization | 3 months and 6 months post-randomization | MACE (Major Adverse Cardiovascular Events): CV-related hospital readmissions; CV and all-cause mortality |
| Exercise Sessions | Baseline through 12-week (36 session) cardiac rehabilitation program | Self-reported number of self-directed exercise sessions per week, confirmed by Fitbit activity tracker data. |
| Functional Capacity | Baseline, 3 months, and 6 months post-randomization | Six-Minute walk test, evaluating blood pressure, oxygen saturation, and pulse after walking for 6 minutes at a normal pace |
| Health-related quality of life | Baseline, 3 months, and 6 months post-randomization | Changes from baseline in health-related quality of life using the Short Form \[SF\]-12 Health Survey, a self-reported outcome measure assessing the impact of health on an individual's everyday life. The SF-12 consists of 12-items and 8 subdomains. Each item of the questionnaire has response categories which vary from 2- to 6-point scales and raw scores for items ranging from 1 to 6. The raw scores are summated and linearly transformed into 0-100 scale with a higher score indicating better health status. |
| Physical Activity Self-regulation | Baseline, 3 months, and 6 months post-randomization | Changes from baseline in physical activity self-regulation measured by the Health Beliefs Survey to assess strategies used in the past 3 months to increase their step count or physical activity levels. Items are measured on a five-point scale from 1 (never) to 5 (repeatedly). Higher scores indicate more self-regulation. |
| Physical Activity Social Support | Baseline, 3 months, and 6 months post-randomization | Changes from baseline in physical activity social support using the Social Support for Exercise Survey scale that asks participants how much encouragement they received to increase physical activity on a five-point scale from 1 (never) to 5 (very often). Higher scores indicate more social support for physical activity. |
| Diet Self-efficacy | Baseline, 3 months, and 6 months post-randomization | Changes from baseline in diet self-efficacy measured the Diet Confidence Survey scale to assess the participant's confidence in their ability to maintain a healthy diet when faced with common barriers. 12 items are assessed, each on a 5-point scale ranging from 1 to 5. A higher total sum indicates higher self-efficacy for healthy eating. |
| Diet Self-regulation | Baseline, 3 months, and 6 months post-randomization | Changes from baseline in diet self-regulation measured by the Health Beliefs Survey to assess strategies used in the past 3 months to eat healthier foods. Items are measured on a five-point scale from 1 (never) to 5 (repeatedly). Higher scores indicate more use of self-regulation strategies to promote healthy eating. |
| Physical Activity Self-efficacy | Baseline, 3 months, and 6 months post-randomization | Changes from baseline in physical activity self-efficacy measured by the Exercise Confidence Survey scale to assess the participant's confidence in their ability to exercise when faced with common barriers. 12 items are assessed, each on a 5-point scale ranging from 1 to 5. A higher total sum indicates higher self-efficacy for physical activity. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORLaPrincess Brewer, M.D., M.P.H.
Mayo Clinic
Outcome results
None listed