Accelerated (Intensive) Cardiac Training for Heart Failure Patients (ACT-HF)

Accelerated (Intensive) Cardiac Training for Heart Failure Patients (ACT-HF)

The purpose of this study is to see if patients undergoing accelerated Intensive Cardiac Rehabilitation (ICR) (2 weeks after discharge) will improve exercise performance as well as on measures of quality of life after a cardiac hospitalization.

Study Overview

• Status: Not yet recruiting
• Conditions: Heart Failure; Cardiac Rehabilitation
• Intervention / Treatment: Other: Early Referral; Other: Standard Of Care (SOC) + Placebo

Detailed Description

The goal of this study is to evaluate the safety and effectiveness of initiating ICR (Intensive Cardiac Rehabilitation) at 2 weeks versus 6 weeks following hospital discharge in patients with HFrEF (Heart Failure with reduced Ejection Fraction). This is a randomized, controlled trial with two parallel groups. The Early Intervention Group with ICR initiated 2 weeks ±2 weeks following hospital discharge and the Usual Care Group with ICR initiated 6 weeks ±2 weeks after hospital discharge. Potential participants will be identified at Missouri Baptist Medical Center and referred for ICR at the HCI (Heart Care Institute) at Barnes Jewish West County Hospital (BJWCH). This study is being funded by the Missouri Baptist Healthcare Foundation.

To be evaluable, participants must complete a minimum of 24 ICR days, scheduled up to three days per week, with the option of completing a maximum of 36 ICR days over a period of up to 12-to-15-weeks post hospital discharge. The study team will analyze the ICR data from the start of ICR through 24 days of ICR. Data after 24 days will only include information on whether a participant continues to complete the maximum 36 days of ICR. During the trial, participants will complete performance tests and PRO (Participant Reported Outcome) surveys and questionnaires. Performance tests include a 6MWT (six minute walk test), a SPPB test (Short Performance Battery Test), and a handgrip test and will be completed at baseline, and the start of ICR and at the end of the completion of the 24th day of ICR.

PROs include a Cardiac Self-Efficacy Questionnaire (survey), Dartmouth COOP General Health Questionnaire (survey), PHQ-9 (survey), Minnesota Living with Heart Failure Questionnaire (MLHFQ), Beck Depression Score (BDS), Rate Your Plate (RYP) and Duke Activity Status Index (DASI). PROs will be completed during baseline, start of ICR, and at the end of the 24th day of ICR.

The Early Intervention Group will repeat performance assessments and PROs 6-weeks (approximately 4-weeks post ICR start-up) following hospital discharge.

• Study Type: Interventional
• Enrollment (Estimated): 20
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Dawson Haley A Haley, B.S.; Phone Number: 314-362-8941; Email: dhaley@wustl.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Age ≥ 18 years of age at the time of consent
2. Diagnosis of HFrEF
3. EF <35% within 3 months of hospital discharge
4. Current hospitalization for a cardiac event (an approved cardiac diagnosis, such as chronic angina, recent MI (heart attack), cardiac surgery, or recent percutaneous coronary intervention (PCI) e.g., stent placement)
5. Agreeable to complete 24 days of ICR and study requirements
6. Ability and willingness to sign the ICF
7. Referred to intensive cardiac rehabilitation at Washington University Heart Care Institute (HCI) at Barnes-Jewish West County Hospital (BJWCH).

Exclusion Criteria:

1. Diagnosis of dementia
2. Significant orthopedic limitations (e.g., double amputee) (walking with a walker is acceptable)
3. Discharge to rehab facility or nursing home
4. Pregnant women
5. Currently enrolled in Hospice, not expected to live for 12 months
6. Undergoing treatment for any type of cancer other than skin cancer
7. History or evidence of any other clinically significant condition that, in the opinion of the investigator, might pose a safety risk to participants or interfere with study procedures, evaluation, or completion.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: 2 weeks post discharge group; Participants will be randomized into a 2 week post discharge group that will start cardiac rehabilitation 2 weeks after discharge compared to normal SOC at 6 weeks post discharge.	Other: Early Referral; Patients will be early referred (2 wks vs 6wks) to cardiac rehabilitation to see if there are benefits to early referral.
Placebo Comparator: 6 weeks post discharge group (SOC); Participants will be randomized into the SOC 6 week post discharge group.	Other: Standard Of Care (SOC) + Placebo; Normal Standard of care 6 week referral time.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety and Tolerability of Accelerated ICR 2 weeks and 6 weeks post-hospital discharge	To evaluate safety/tolerability of accelerated ICR beginning 2 weeks post-hospital discharge compared to usual standard care ICR beginning 6 weeks post-hospital discharge in patients with HFrEF. Safety will be determined by incidence of adverse events from randomization through 24 days after ICR initiation. Tolerability will be measured by number of ICR days attended (out of the required 24 ICR days).	From enrollment, to completion of at least 24 cardiac rehabilitation days.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Efficacy of enrollment rates in Cardiac Rehabilitation	To evaluate efficacy of early ICR (2 weeks post-hospital discharge) compared to usual care ICR (6 weeks post-hospital discharge) in patients with HFrEF. Efficacy and tolerability will be assessed from baseline through completion of 24 ICR days: • Changes in exercise performance in six minute walk test.	From enrollment, to at least the completion of 24 cardiac rehabilitation days.
Efficacy of enrollment rates in Cardiac Rehabilitation	To evaluate efficacy of early ICR (2 weeks post-hospital discharge) compared to usual care ICR (6 weeks post-hospital discharge) in patients with HFrEF. Efficacy and tolerability will be assessed from baseline through completion of 24 ICR days: • Changes in exercise performance in Short Performance Battery Test.	From enrollment, to at least the completion of 24 cardiac rehabilitation days.
Efficacy of enrollment rates in Cardiac Rehabilitation	To evaluate efficacy of early ICR (2 weeks post-hospital discharge) compared to usual care ICR (6 weeks post-hospital discharge) in patients with HFrEF. Efficacy and tolerability will be assessed from baseline through completion of 24 ICR days: • Changes in exercise performance in handgrip dynamometer test.	From enrollment, to at least the completion of 24 cardiac rehabilitation days.
Efficacy of enrollment rates in Cardiac Rehabilitation	To evaluate efficacy of early ICR (2 weeks post-hospital discharge) compared to usual care ICR (6 weeks post-hospital discharge) in patients with HFrEF. Efficacy and tolerability will be assessed from baseline through completion of 24 ICR days: • Changes in Patient Reported Outcomes (PROs): Cardiac Self-Efficacy Questionnaire.	From enrollment, to at least the completion of 24 cardiac rehabilitation days.
Efficacy of enrollment rates in Cardiac Rehabilitation	To evaluate efficacy of early ICR (2 weeks post-hospital discharge) compared to usual care ICR (6 weeks post-hospital discharge) in patients with HFrEF. Efficacy and tolerability will be assessed from baseline through completion of 24 ICR days: • Changes in Patient Reported Outcomes (PROs): Dartmouth COOP General Health Questionnaire	From enrollment, to at least the completion of 24 cardiac rehabilitation days.
Efficacy of enrollment rates in Cardiac Rehabilitation	To evaluate efficacy of early ICR (2 weeks post-hospital discharge) compared to usual care ICR (6 weeks post-hospital discharge) in patients with HFrEF. Efficacy and tolerability will be assessed from baseline through completion of 24 ICR days: • Changes in Patient Reported Outcomes (PROs): Minnesota Living with Heart Failure Questionnaire (MLHFQ)	From enrollment, to at least the completion of 24 cardiac rehabilitation days.
Efficacy of enrollment rates in Cardiac Rehabilitation	To evaluate efficacy of early ICR (2 weeks post-hospital discharge) compared to usual care ICR (6 weeks post-hospital discharge) in patients with HFrEF. Efficacy and tolerability will be assessed from baseline through completion of 24 ICR days: • Changes in Patient Reported Outcomes (PROs): Beck Depression Score (BDS)	From enrollment, to at least the completion of 24 cardiac rehabilitation days.
Efficacy of enrollment rates in Cardiac Rehabilitation	To evaluate efficacy of early ICR (2 weeks post-hospital discharge) compared to usual care ICR (6 weeks post-hospital discharge) in patients with HFrEF. Efficacy and tolerability will be assessed from baseline through completion of 24 ICR days: • Changes in Patient Reported Outcomes (PROs): Rate Your Plate (RYP)	From enrollment, to at least the completion of 24 cardiac rehabilitation days.
Efficacy of enrollment rates in Cardiac Rehabilitation	To evaluate efficacy of early ICR (2 weeks post-hospital discharge) compared to usual care ICR (6 weeks post-hospital discharge) in patients with HFrEF. Efficacy and tolerability will be assessed from baseline through completion of 24 ICR days: • Changes in Patient Reported Outcomes (PROs): Duke Activity Status Index (DASI)	From enrollment, to at least the completion of 24 cardiac rehabilitation days.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rehospitalization and All- Cause Morality within 6 Months Post-Hospital Discharge	To evaluate rehospitalization and all-cause mortality within 6 months post-hospital discharge for HFrEF patients enrolled in early ICR (2 weeks post-hospital discharge) compared to usual care ICR (6 weeks post-hospital discharge).I ncidence of rehospitalization and, all-cause mortality and deaths from randomization through the 6-month follow up phone call.	Enrollment to within 6 months post-hospital discharge

Collaborators and Investigators

• Sponsor: Washington University School of Medicine
• Investigators: Principal Investigator: Linda R Peterson, M.D., Washington University School of Medicine

Study record dates

Study Major Dates

• Study Start (Estimated): October 1, 2026
• Primary Completion (Estimated): November 1, 2026
• Study Completion (Estimated): November 1, 2027

Study Registration Dates

• First Submitted: September 21, 2026
• First Submitted That Met QC Criteria: September 28, 2026
• First Posted (Actual): October 5, 2026

Study Record Updates

• Last Update Posted (Actual): October 5, 2026
• Last Update Submitted That Met QC Criteria: September 28, 2026
• Last Verified: September 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Heart Diseases; Heart Failure; Health Services Administration; Health Care Quality, Access, and Evaluation; Quality of Health Care; Quality Indicators, Health Care; Standard of Care
• Other Study ID Numbers: 202603003; GR0041819 (Other Grant/Funding Number: Missouri Baptist Healthcare Foundation)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No