Improving Veteran Referral to Cardiac Rehabilitation

Improving Veteran Referral to Cardiac Rehabilitation: A Hybrid Effectiveness-Implementation Trial

This study will test whether the Veterans Cardiac Rehabilitation Referral Program (VCR2P) improves cardiac rehabilitation participation by studying 816 Veterans across three VA medical centers in Nashville, Dallas, and Gainesville over 12 months. The trial compares referral rates from the 6 months before implementing the program to 6 months after, using a "before and after" design since randomization would be impractical. The study will measure whether the program increases the proportion of eligible Veterans who receive cardiac rehabilitation referrals and whether more Veterans actually attend rehabilitation sessions. Additionally, focus groups with physicians, nurses, and Veterans will identify what helps or hinders the program's success, providing essential insights for expanding this intervention to other VA facilities nationwide if it proves effective.

Study Overview

• Status: Recruiting
• Conditions: Cardiovascular Disease; Cardiac Rehabilitation
• Intervention / Treatment: Behavioral: Veterans Cardiac Rehabilitation Referral Program

Detailed Description

This study seeks to evaluate the Veterans Cardiac Rehabilitation Referral Program (VCR2P) using a type 2 hybrid effectiveness-implementation design. The trial involves a single-arm, pre-post trial at three VA medical centers, enrolling a total of 816 Veterans who are eligible for cardiac rehabilitation (CR). The primary objective is to assess the program's impact on two key outcomes: CR referral rates and CR initiation rates. Secondary implementation outcomes will include measures such as reach, adoption, fidelity, maintenance, and cost, providing a comprehensive understanding of how the intervention performs in real-world VA settings. This evaluation will be guided by implementation science frameworks to ensure the program is scalable and sustainable. A summative evaluation will be conducted to inform broader implementation across the Veterans Health Administration. The goal is to determine not only whether VCR2P improves referral and participation in CR but also how it can be feasibly integrated into routine care to close quality gaps and enhance cardiovascular outcomes for Veterans.

• Study Type: Interventional
• Enrollment (Estimated): 816
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Justin M Bachmann, MD MPH; Phone Number: (615) 327-4751; Email: justin.bachmann2@va.gov
• Study Contact Backup: Name: Ray Stokes Peebles, MD; Phone Number: (615) 327-4751; Email: Ray.Peebles@va.gov

Study Locations

• United States
  • Florida
    • Gainesville, Florida, United States, 32608-1135
      • Recruiting
      • North Florida/South Georgia Veterans Health System, Gainesville, FL
      • Contact: David E Winchester, MD MS BS; Phone Number: 7563 352-548-6000; Email: David.Winchester@va.gov
      • Sub-Investigator: David E Winchester, MD MS BS
  • Tennessee
    • Nashville, Tennessee, United States, 37212-2637
      • Recruiting
      • Tennessee Valley Healthcare System Nashville Campus, Nashville, TN
      • Contact: Justin M Bachmann, MD MPH; Phone Number: 615-327-4751; Email: justin.bachmann2@va.gov
      • Principal Investigator: Justin M Bachmann, MD MPH
      • Contact: Ray Stokes Peebles, MD; Phone Number: (615) 327-4751; Email: Ray.Peebles@va.gov
  • Texas
    • Dallas, Texas, United States, 75216-7167
      • Recruiting
      • VA North Texas Health Care System Dallas VA Medical Center, Dallas, TX
      • Contact: Katherine C Michelis; Phone Number: 214-857-1472; Email: katherine.michelis@va.gov
      • Sub-Investigator: Katherine C Michelis

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• All Veterans hospitalized with acute myocardial infarction, percutaneous coronary intervention, cardiac valve surgery, coronary artery bypass grafting, or systolic heart failure at the three participating VA medical centers (Nashville, Dallas, and Gainesville).

Exclusion Criteria:

• No exclusion criteria during the intervention period

  • however, post-hoc analysis will exclude Veterans with documented reasons preventing CR attendance including death during hospitalization or within 30 days of discharge, discharge to inpatient rehabilitation or skilled nursing facilities, significant cognitive impairment, high-risk ventricular arrhythmias, or explicit refusal of CR services.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Veterans Cardiac Rehabilitation Referral Program; All eligible Veterans hospitalized with cardiac rehabilitation-eligible conditions (acute myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, cardiac valve surgery, or systolic heart failure) will receive the VCR2P intervention.

Behavioral: Veterans Cardiac Rehabilitation Referral Program; A CDS tool that identifies Veterans hospitalized with CR-eligible conditions and prompts physicians to refer them to CR.; Educational materials that explain to Veterans the benefits and importance of participating in CR.; Defined responsibilities for a facility-based CR referral coordinator who will support development and oversight of the referral process.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cardiac rehabilitation referral	Proportion of eligible Veterans referred to cardiac rehabilitation.	From hospital admission to 30 days after discharge

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cardiac rehabilitation initiation	Proportion of eligible Veterans attending at least one cardiac rehabilitation session.	Within 6 months of hospital discharge

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Investigators: Principal Investigator: Justin M Bachmann, MD MPH, Tennessee Valley Healthcare System Nashville Campus, Nashville, TN

Study record dates

Study Major Dates

• Study Start (Actual): February 23, 2026
• Primary Completion (Estimated): July 1, 2028
• Study Completion (Estimated): December 31, 2029

Study Registration Dates

• First Submitted: July 14, 2025
• First Submitted That Met QC Criteria: July 14, 2025
• First Posted (Actual): July 23, 2025

Study Record Updates

• Last Update Posted (Actual): June 17, 2026
• Last Update Submitted That Met QC Criteria: June 15, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Cardiac Rehabilitation; Hybrid Effectiveness-Implementation Trial
• Additional Relevant MeSH Terms: Cardiovascular Diseases
• Other Study ID Numbers: IIR 23-171

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No